Hamza Sunman

Serum uric acid levels predict the severity and morphology of coronary atherosclerosis detected by multidetector computed tomography.

In this study, we aimed to evaluate whether serum uric acid (UA) was associated with the severity and morphology of coronary atherosclerotic plaques (CAP) shown by multidetector computed tomography (MDCT). The study population consisted of 982 patients (58% men) who underwent dual-source 64 slice MDCT for the assessment of coronary artery disease (CAD). Coronary arteries were evaluated on 16 segment basis and critical coronary plaque was described as luminal narrowing >50%, whereas plaque morphology was assessed on per segment basis. Serum UA levels were determined using commercially available assay kits. The critical atherosclerotic lesions were detected in 454/982 (46.2%) subjects by MDCT. Serum UA levels were found to be higher in patients with any coronary plaque (6.9 ± 1.5mg/dL vs. 5.1 ± 1.3mg/dL, p<0.01). Also UA level was higher in patients with critical stenosis compared to non-critical stenosis (6.1 ± 1.5mg/dL vs. 5.4 ± 1.3mg/dL, p<0.001). Subjects having primarily calcified plaques have higher UA levels compared to other plaque subtypes (5.5 ± 1.3 for non-calcified plaques, and 5.6 ± 1.2 for mixed plaques, 6.6 ± 1.6 for calcified plaques, p<0.001). This independent association was remained after multinominal regression analysis (OR: 1,987; 95% CI; 1.69-2.32; p<0.01). Our study demonstrated that serum UA level was significantly associated with the severity and the calcified morphology of CAP detected by MDCT. Further prospective clinical studies are needed to clarify the exact physiopathologic role of UA in CAD.

Increased epicardial fat tissue is a marker of metabolic syndrome in adult patients

BACKGROUND Human epicardial adipose tissue (EAT) is a type of visceral adipose tissue functioning as a metabolically active endocrine organ by secreting several hormones and adipocytokines. In this study, we aimed to assess the relationship between EAT measured by dual source multidetector computed tomography (MDCT) and the presence and components of metabolic syndrome (MS). METHODS A total of 83 patients (43.4% male, mean age 56.1 ± 11.9) who underwent MDCT for suspected coronary artery disease were enrolled in this study. Thickness of the EAT was measured on contrast enhanced multiplanar reformat images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view. RESULTS The mean EAT thickness was significantly increased in patients with MS compared to those without MS (8.49 ± 1.43 mm vs 7.39 ± 2.10 mm, p<0.001). Additionally there was a graded relationship between increasing number of MS components and mean total EAT and pericoronary fat thickness (p<0.05). Simple regression analysis revealed that the presence of MS, age and body mass index (BMI) were correlated with mean EAT thickness (r=0.398, r=0.376 and r=0.371 respectively, p<0.001). Multiple regression analysis revealed that the presence of MS, age and BMI were the strongest independent variables related to EAT. CONCLUSION In this study we demonstrated that EAT and pericoronary fat thickness were associated with the presence of MS. Those findings may implicate that, EAT and pericoronary fat may be a novel and useful indicator for MS.

Fragmented QRS Complex Predicts the Arrhythmic Events in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Fragmented QRS (frQRS) complex, with various morphology, has been recently described as a diagnostic criterion of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, there are little data regarding the prognostic role of frQRS in these patients. Therefore, we aimed to investigate the association of frQRS with arrhythmic events in patients with ARVC/D.

A Prospective DE-MRI Study Evaluating the Role of TGF-β1 in Left Atrial Fibrosis and Implications for Outcomes of Cryoballoon-Based Catheter Ablation: New Insights into Primary Fibrotic Atriocardiomyopathy

Transforming growth factor (TGF)‐β1 mediated atrial fibrosis plays a major role in the development of vulnerable atrial substrate for atrial fibrillation (AF). Although cryoablation effectively eliminates the triggers for AF, the impact of atrial substrate on the success of cryoablation remains unclear.

Association between family history of premature coronary artery disease and coronary atherosclerotic plaques shown by multidetector computed tomography coronary angiography

BACKGROUND There is controversy regarding the role of family history (FH) of premature coronary artery disease (CAD) as an independent risk factor for CAD. Herein, we aimed to assess the role of FH of premature CAD in prediction of coronary atherosclerosis shown by multidetector computed tomography (MDCT) coronary angiography. METHODS We analyzed consecutive subset of 349 patients in whom MDCT coronary angiography was performed for suspected CAD. All patients underwent coronary MDCT imaging using dual-source MDCT scanner. Coronary arteries were evaluated on 16-segment basis, critical CAP was described as luminal narrowing >50%, whereas plaque morphology was assessed on per segment basis. RESULTS Study population consisted of 202 (57.9%) male and 147 (42.1%) female patients with mean age of 57.8 ± 10.8 years. The presence of CAP was higher in patients with FH of premature CAD in LAD and Cx compared to patients without FH of premature CAD (70.8% vs 58.0%, p=0.013 for LAD; 42.3% vs 30.4%, p=0.021 for Cx; 34.5% vs 29.8%, p=0.348 for RCA).In multinominal logistic regression analysis age, male gender, dyslipidemia and FH of premature CAD seemed significant predictors of primarily noncalcified CAP(OR:1.17, 95% CI:1.07-1.15, p<0.001; OR:0.19, 95% CI:0.09-0.38, p<0.001; OR:2.26, 95% CI:1.21-4.24, p=0.01; OR:3.32, 95% CI:1.74-6.34, p<0.001 respectively) after adjustment for other risk factors. CONCLUSION Our study results indicate that FH of premature CAD is associated with severity, extent and noncalcified CAP shown by MDCT. Further investigation is needed to clarify the exact diagnostic and prognostic role of MDCT coronary angiography in subjects with positive FH and suspected CAD.

Can Admission Neutrophil to Lymphocyte Ratio Predict Infarct-Related Artery Patency in ST-Segment Elevation Myocardial Infarction.

Objectives: In this study, we aimed to investigate the relationship between neutrophil to lymphocyte ratio (NLR) and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 349 patients with STEMI were recruited to this retrospective study. Baseline characteristics were reviewed. Patency of IRA was evaluated by thrombolysis in myocardial infarction flow grade. Results: Of all patients, 293 patients formed the occluded IRA group and 56 patients formed the patent IRA group. The NLR was significantly higher in occluded IRA group (4.4 ± 4.1 vs 1.9 ± 1.1, P < .001). Glucose levels were also higher in occluded IRA group (171.3 ± 78.0 vs 144.7 ± 49.7, P = .022). Regression analysis demonstrated admission NLR and plasma glucose levels as independent predictors of IRA patency. Conclusion: In this study, we found that admission NLR and glucose levels were higher in patients with occluded IRA than in patients with STEMI. We also found that NLR and glucose levels were independent predictors of IRA patency. Because hemogram is a cheap, fast, and widely available test, it can be used in daily practice as a predictor of IRA patency.

Relationship between neutrophil to lymphocyte ratio and slow coronary flow.

Objectives: We evaluated the relationship between neutrophil to lymphocyte ratio (NLR) and slow coronary flow (SCF). Methods: A total of 180 participants were recruited to the present study. Of all the participants, 82 patients were with SCF and 98 participants were with normal coronary arteries. Basal characteristics were recorded. Coronary flow was quantified by thrombolysis in myocardial infarction frame count. Results: Basal characteristics were similar between the 2 groups. The NLR was significantly higher in the SCF group when compared to the control group (2.3 ± 0.8 and 1.5 ± 0.4 respectively, P < .001). In multiple logistic regression analysis, NLR remained as the independent predictor of SCF (P < 0.001). Conclusions: Our findings showed that NLR was significantly higher in the SCF group when compared to the control group with normal coronary arteries. We also showed that NLR was related to the presence of SCF rather than the extent of SCF. Besides these findings, we also showed the NLR as an independent predictor of SCF.

Cardiovascular risk and coronary atherosclerotic plaques detected by multidetector computed tomography: Framingham and SCORE risk models underestimate coronary atherosclerosis in the symptomatic low-risk Turkish population.

ObjectiveIn this study, we investigated the association between cardiovascular (CV) risk factors and coronary atherosclerotic plaque (CAP) burden/subtypes shown by multidetector computed tomography in symptomatic patients free of known coronary artery disease (CAD). MethodsIn 662 consecutive outpatients (56.9±10.7 years, 50.8% men) without known CAD, 64-slice multidetector computed tomography coronary angiography was performed for detection of CAD. Risk estimation for CV outcomes was assessed using the Systematic Coronary Risk Evaluation (SCORE) and the Framingham Risk Score (FRS). Logistic regression analysis was used to evaluate the association of CV risk factors with the prevalence/extent of CAP. ResultsCAP was detected in 318 (48.0%) individuals. Male sex, older age, hypertension, diabetes mellitus, smoking, and dyslipidemia all increased the likelihood of the presence of CAP in univariate analysis (P<0.001). Older age, male sex, dyslipidemia, and diabetes mellitus independently increased the likelihood of the presence of CAP in multivariate analysis (P<0.005). Multinominal logistic regression analysis showed an association with older age, male sex, dyslipidemia, and smoking for noncalcified plaques; with older age, male sex, diabetes, and dyslipidemia for mixed plaques; and with older age and male sex for calcified plaque. Patients with low FRS and SCORE showed a large number of CAPs (33.8 and 40.4%), although CAP was more prevalent in the high-risk groups (67 and 78%, respectively). ConclusionCV risk stratification using only risk factor-based scores is a weak discriminator of the overall CAP burden in individual patients. Many patients with low FRS or SCORE with substantial CAP might be undertreated or not treated at all.

Prognosis of patients with mild–moderate coronary artery stenosis detected by coronary computed tomography angiography

BACKGROUND In addition to the diagnostic performance, coronary computed tomography angiography (CTA) can give important data regarding the prognosis of coronary artery disease (CAD). In this study we aimed to evaluate the prognostic role of coronary CTA in patients with suspected CAD and mild-moderate coronary stenosis. METHODS A total of 1115 patients (602 male, 54%; age 58.4 ± 11.4) without previous CAD were enrolled. Patients underwent coronary CTA imaging using dual-source 64-slice CT scanner. For categorization of the coronary atherosclerotic plaques (CAP), the coronary system was divided into 16 separate segments. For each segment, CAPs were categorized as: calcified, noncalcified and mixed. RESULTS During follow-up of 29.7 ± 13.2 months, cardiovascular events defined as ST segment elevation myocardial infarction (4 patients), non-ST segment elevation myocardial infarction (5 patients) and unstable angina pectoris (20 patients) requiring revascularization or hospital admission were recorded. Cox hazard regression analysis revealed an association between the severity of luminal stenosis (HR: 4.73, 95% CI: 1.36-16.47, p<0.05) and extent (HR: 1.10, 95% CI: 1.00-1.22, p=0.051) and the adverse coronary events in the follow-up. Multivariate Cox hazard regression analysis revealed that nonobstructive (≤ 50%) lesions were the only factor causing increased probability of coronary events in the follow-up (HR: 4.77, 95% CI: 1.36-16.74, p<0.05). CONCLUSION The presence and severity of luminal stenosis shown by coronary CTA were associated with prognosis of coronary events in the follow-up. These results may improve the risk stratification in patients evaluated by coronary CTA and provide strategies for the individualized prevention programs.

Transcatheter Interatrial Septal Defect Closure in a Large Cohort: Midterm Follow-up Results

OBJECTIVES We evaluated immediate and midterm results of transcatheter closure of atrial septal defects (ASDs) and patent foramen ovale (PFO) using various closure devices. MATERIALS AND METHODS The study included four hundred fourteen patients (one hundred eighty-two men, two hundred thirty-two women; mean age 39 ± 12.3 years; range 17-67 years) who underwent transcatheter closure of secundum ASD (n = 193) or PFO (n = 221). All the patients were evaluated by transthoracic echocardiography and transesophageal echocardiography before the procedure. Transcatheter closure was performed by using Amplatzer (n = 184), Occlutech Figulla (n = 209), or BioSTAR (n = 21) devices. Closure of ASDs was performed under general anesthesia with transesophageal echocardiography guidance, and closure of PFOs was performed under local anesthesia with transthoracic echocardiography guidance. Follow-up controls were at 1, 6, and 12 months and annually thereafter. The median follow-up periods of ASD and PFO patients were 43 and 30 months. RESULTS The mean device size was 19.3 ± 6.2 mm for ASD patients and 24.6 ± 2.6 mm for PFO patients. The mean procedural and fluoroscopy times were 22.3 ± 4.7 and 4.1 ± 1.9 minutes for ASD closure and 12.4 ± 3.2 and 3.1 ± 1.2 minutes for PFO closure, respectively. Procedural device embolization occurred in only two patients (0.48%). During follow-up, recurrent embolic events occurred in four patients (1.8%) after PFO closure, and no residual shunts were seen after ASD closure. Device thrombosis developed in two ASD patients during the procedure and in one PFO patient at 12th month of the follow-up (0.72%). CONCLUSION Transcatheter closure of PFOs and secundum-type ASDs using the Amplatzer, Occlutech Figulla, and BioSTAR devices is an efficacious and safe therapeutic option.