Halil Kisacik

Late recurrence of left atrial myxoma with multiple intracranial aneurysms

Atrial myxomas are rare tumors. They occur in less clinical history. In her neurological examination, no than 0.05% of the population, but they constitute persisting deficit was noticed. She was, then, conapproximately 50% of primary cardiac neoplasms [1]. sulted to the neurology department for differential They are true neoplasms thought to be derived from diagnosis of severe headache. At her contrast-enpluripotential subendocardial mesenchymal cells [2]. hanced computerized tomographic examination of the These tumors present with systemic embolization in cranium, she was noticed to have many commaup to 45% of cases [3,4], with the cerebral circulation shaped enhancing lesions one of which was a giant being involved in one-half of these instances [5]. aneurysm on the left side. She was, then, referred to Cerebral ischemia resulting from direct tumor emthe neurosurgery department on an urgent basis. bolization is the most common neurological preFollowing her hospitalisation in the neurosurgery sentation [6]. Other rare neurological manifestations department, she underwent cerebral angiography in include parenchymal brain metastasis [7], intracerebrwhich there were multiple fusiform aneurysms on al hemorrhage [5] and oncotic aneurysm formation both carotid artery territories, one of which was a [1,8]. With rare exceptions, neurological symptoms giant aneurysm on the left middle cerebral artery related to atrial myxomas occur before or at the time artery locus (Fig. 1) of primary tumor diagnosis. We describe a patient Treatment with coil embolization of the aneurysm who presented with transient neurological symptoms was decided due to localisation of the giant 25 years after complete resection of left atrial myxaneurysm. Before the procedure, since she was oma as initial finding of late recurrence. known to have resection of myxoma, an echocardiogA 38-year-old woman was admitted to our raphy was performed and a mass lesion originating emergency department with chief complaints of from the posterior wall of the left atrium with severe headache and episodes of right sided weakmultiple, mobile, papillary extensions towards mitral ness. She was normotensive having 115/75 mmHg valve was noted (Fig. 2). Following coil embolization systolic /diastolic blood pressures and known to have of the giant aneurysm, she was referred to our left atrial myxoma resection 25 years ago in her department and operated successfully for the mass lesion. Pathology confirmed our diagnosis and the diagnosis for the late recurrence of the myxoma at the first site was established. She has been followed up *Corresponding author. SSK Bloklari 70 /7 06170, Yenimahalle /Anby our clinic uneventfully for both recurrence and kara, Turkey. Tel.: 190-312-346-9401. E-mail address: cardioceptor@ttnet.net.tr (M.B. Yilmaz). progression or regression of cerebral aneurysms.

Left ventricular thrombosis is associated with increased mean platelet volume in patients with dilated cardiomyopathy and sinus rhythm.

Objective — Dilated cardiomyopathy has been associated with left ventricular thrombosis, which leads to substantial morbidity and mortality as a site for peripheral emboli.There are some studies on patients with dilated cardiomyopathy showing altered haemostasis and platelet behaviour despite sinus rhythm. Mean platelet volume, which is the most accurate and simple estimate of platelet reactivity, may be associated with the development of left ventricular thrombosis. Methods and results — We prospectively enrolled 48 consecutive patients with dilated cardiomyopathy and sinus rhythm with left ventricular thrombosis and compared them with an age-sexmatched control group having dilated cardiomyopathy without left ventricular thrombosis.We found that in patients with left ventricular thrombosis mean platelet volume is significantly higher than those without (9.5 ± 0.8 vs. 8.7 ± 0.6, p < 0.001). Conclusions — Mean platelet volume is increased in patients with dilated cardiomyopathy and sinus rhythm having left ventricular thrombosis. This might be reflecting a causal relationship, which in turn requires further study to establish the role of antiplatelet agents both in prevention and in treatment

Platelet to Lymphocyte Ratio as a Prognostic Marker of In-Hospital and Long-Term Major Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction.

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) on in-hospital and long-term major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in a large prospective study. Patients (n = 1938) admitted with acute STEMI within 12 hours of symptom onset and who underwent pPCI between January 2010 and January 2015 were followed up for 31.6 ± 16.2 months. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, nonfatal myocardial infarction, and mortality were higher in the third PLR tertile group. A PLR in the third tertile had 2.4-fold increased risk of in-hospital MACE and 2.8-fold risk of long-term MACE. The PLR was significantly and positively correlated with peak creatine kinase MB (CK-MB) levels (r = 0.562, P < .001) and Gensini score (r = 0.408, P < .001). Kaplan-Meier analysis of long-term MACE-free survival revealed a higher occurrence of MACE in the third PLR tertile group compared to the other tertiles. In conclusion, the PLR may be a marker of inflammatory and prothrombotic status and predicted in-hospital and long-term MACE in a population with STEMI.

Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome

BACKGROUND We aimed to investigate the usefulness of monocyte to HDL cholesterol ratio (MHR) in predicting coronary artery disease severity and future major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). METHODS 2661 patient with ACS were enrolled and followed up during median 31.6 months. RESULTS MHR were significantly positively correlated with neutrophil to lymphocyte ratio (r=0.438), CRP (r=0.394), Gensini (r=0.407), and SYNTAX score (r=0.333). During in-hospital and long-term follow-up, MACE, stent thrombosis, non-fatal MI, and mortality occurred more frequently in the third tertile group. Kaplan-Meier analysis revealed the higher occurrence of MACE in the third tertile group compared with other tertiles. Adjusting for other factors, a MHR value in the third tertile group was determined as an independent predictor of in-hospital and long-term MACE. CONCLUSIONS MHR as a novel inflammation-based marker seemed to be an independent predictor of severity of coronary artery disease and future cardiovascular events in patients with ACS. MHR may utilise the identification of patients who are at higher risk for MACE and individualisation of targeted therapy.

Coagulation, fibrinolytic system activation and endothelial dysfunction in patients with mitral stenosis and sinus rhythm

Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p<0.05). Whether the rhythm was sinus or AF, fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly higher in patients with LASEC than in the control group (p<0.05). Only PF 4 was higher in the AF group than in those with sinus rhythm (p<0.05). As to plasminogen activator and PAI-I levels, only tissue plasminogen activator levels were found to be higher in the AF group than in those with sinus rhythm and the control group (p<0.05). In patients with mitral stenosis and sinus rhythm, if LASEC is present, coagulation activation, platelet activation, and endothelial dysfunction are similar in patients with AF, and anticoagulation should be considered in these patients.

Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease

AIM We aimed to investigate whether baseline monocyte to high-density lipoprotein cholesterol ratio (MHR), an easily available inflammatory and oxidative stress marker, is associated with SYNTAX score. PATIENTS & METHODS In this cross-sectional study, n = 1229 consecutive patients with coronary artery disease were classified into two groups, low SYNTAX score (≤22) and high SYNTAX score (≥23). RESULTS MHRs were significantly higher in patients with high SYNTAX score (p < 0.05). In multivariate regression analysis, MHR remained as independent predictor of high SYNTAX score together with C-reactive protein (CRP), hypertension and diabetes mellitus. In correlation analysis, MHR showed significant positive correlations with SYNTAX score (r = 0.371, p < 0.001) and CRP level (r = 0.336, p < 0.001). CONCLUSION This study suggests MHR is independently associated with burden of coronary atherosclerosis.

Beta-blocker-induced psoriasis: a rare side effect--a case report.

Beta blockers are one of the oral agents shown to decrease cardiovascular morbidity and mortality rates in randomized, controlled trials, and hence, they are widely used for the management of many cardiovascular situations. In terms of side effects there are 3 major modes of action: (1) contraction of smooth muscles, particularly of bronchi with nonselective agents; (2) exaggerated cardiac effects; and (3) central nervous system effects. There are also some rare side effects of beta blockers, some of which are unpredictable, but the others are related to mode of action at the cellular level. Beta-blocking agents may cause psoriaform eruptions and worsen existing psoriasis. Psoriasis may be an inconvenient side effect of beta blockade. Herein, we report a case of beta-blocker-induced psoriasis.

Prevalence of angiographically significant coronary artery disease in patients with rheumatic mitral stenosis.

Objective — In order to evaluate the prevalence of angiographically significant coronary artery disease (CAD) in patients with predominant mitral stenosis (mitral valve area ≤ 1.5 cm2), coronary angiograms of the 837 consecutive patients with mitral stenosis (482 women and 355 men; median age = 50 years [ranging from 35 to 77]) were retrospectively analysed. Methods and results — Significant CAD was defined as at least 50% diameter narrowing of a major coronary artery. Significant CAD was detected in 63 patients (7.5%, 30 men and 33 women). Patients with CAD were significantly older than those without CAD (median: 59 vs. 49 years; p < 0.0001, respectively). With respect to coronary risk factors, diabetes mellitus (28.6% vs. 9.4%; p < 0.0001), hypertension (46% vs. 16.7%; p < 0.0001) and family history of CAD (34.9% vs. 17.3%; p = 0.001) were significantly more frequent in the CAD+ group as compared to the CAD- group. Serum levels of cholesterol were significantly higher in CAD+ group as compared to the CADpatients (median: 199 vs. 176 mg/dl; p = 0.003). No significant differences were noted between the two groups in both serum levels of HDL-cholesterol (p = 0.12) and triglycerides (p = 0.08). Of the 63 patients with CAD, 21 (33.3%) had angina pectoris (AP) and, in patients free of CAD, AP was present in 106 (13.7%).The sensitivity and specificity of AP for the presence of significant CAD were 33.3% and 86.3%, respectively. The positive predictive value of AP for the presence of CAD was 16.5% and the negative predictive value of its absence was 94.1%. Conclusion — It is concluded that routine coronary angiography is not necessarily indicated in predominant mitral stenosis particularly in patients who are younger than 40 years and have no coronary risk factors and typical chest pain.

Mean platelet volume: an important predictor of coronary collateral development.

Collaterals, which develop in response to ischemic stimuli derived from coronary artery disease (CAD), contribute to reduction of infarct size, left ventricular dysfunction, and mortality. However, there is considerable variation among patients with coronary heart disease regarding the extent of coronary collateral development (CCD). In this study, we aimed to investigate the association of the degree of platelet activation via mean platelet volume (MPV) with coronary collateral circulation. Therefore, 210 patients who underwent coronary angiography and had coronary stenosis ≥50 % in at least one coronary artery were included in the study. Clinical information and analyses of blood samples were obtained from a review of the patients’ chart. Blood samples for MPV were analyzed by K3 EDTA and collateral vessels were graded according to the Rentrop classification. In the study group, 150 of the 210 patients were found to have inadequate CCD. Although there was no difference between the two groups with regard to platelet count, MPV levels were significantly higher in the patients who had inadequate CCD (11.3 ± 1.0 fl vs. 9.5 ± 1.5 fl, p < 0.001). Furthermore, the Gensini score was significantly lower in patients who had inadequate CCD (45 ± 46 vs. 91 ± 35, p < 0.001). MPV, Gensini score, age, female gender, total cholesterol, red cell distribution width, triglyceride, and fasting glucose levels were found to have univariate association with poor CCD. In multivariate logistic regression model, MPV (OR = 2.45, p < 0.001) and Gensini score (OR = 0.98, p < 0.001) were found to be the independent predictors of impaired CCD. In receiver operator characteristic curve analysis, optimal cut-off value of MPV to predict inadequate CCD was found as >9.6 fl, with 96% sensitivity and 84.7% positive predictive value. In conclusion, we can say that MPV is an important, simple, effortless, and cost effective tool and can be useful in predicting the CCD in patients with significant CAD.

A new echocardiographic parameter of aortic stiffness and atherosclerosis in patients with coronary artery disease: Aortic propagation velocity

BACKGROUND In this study, a novel echocardiographic parameter in the evaluation of the presence of coronary artery disease (CAD) and aortic stiffness, aortic propagation velocity, was measured and compared with other conventional aortic stiffness parameters such as aortic strain and aortic distensibility. Also, the relation between aortic propagation velocity and carotid intima media thickness was evaluated. METHOD AND RESULTS A total of 51 patients with CAD and 42 patients with normal coronary arteries as a non-CAD group were included in the study. Aortic propagation velocity was significantly lower in the CAD group (p<0.001). A statistically significant relation was detected between aortic propagation velocity and the maximum, mean, and overall carotid intima media thickness values for right and left carotid arteries (p<0.001). There was a statistically significant relation between aortic propagation velocity, aortic strain, and aortic distensibility (r=0.556, p<0.001 and r=0.483, p<0.001 respectively). CONCLUSION Aortic propagation velocity is a novel and simple echocardiographic parameter of aortic stiffness which is feasible for non invasive cardiovascular risk stratification and selection of high risk individuals for CAD.