Hüseyin Dursun

Echocardiographic signs of right ventricle changes after Trastuzumab treatment in breast cancer patients with erb-2 overexpression.

Objective: Left ventricular (LV) dysfunction after trastuzumab treatment in erb-2 breast cancer cases has been fully investigated. However, there is not enough data about the effect of trastuzumab treatment on right ventricular (RV) functions. This study is designed to evaluate the right heart changes by performing echocardiography after trastuzumab treatment in patients with erb-2 breast cancer. Methods: Forty-two consecutive breast cancer patients with erb-2 overexpression mean age 50.4±11.6 years who were decided to receive trastuzumab treatment were enrolled. Echocardiographic examinations including 2-D, spectral, and tissue Doppler measurements were performed at the baseline (T1) and repeated after 6 months (T2). Results: Tricuspid annular plane systolic excursion (TAPSE) was decreased, RV myocardial performance index (RVMPI) and tricuspid E/e’ ratio was increased after trastuzumab treatment (1.84 vs. 2.14; p<0.01) (0.46 vs. 0.56, p<0.01) (4.4±1.07 vs. 5.08±1.46; p=0.04). Median serum NT-ProBNP levels, troponin I, and hs-CRP levels were similar between the groups. LVEF and TAPSE were negatively correlated with dosage of trastuzumab (r=-0.392, p=0.04; r=-0.522, p=0.006). There was a stepwise decrease in LVEF when trastuzumab used with anthracyclines however this not reached statically significant (62.4±2, 60±4.5; p=0.06). Conclusion: In our study; we observed a trend of RV deterioration after trastuzumab treatment. These preliminary RV changes were demonstrated by using TAPSE, RV tissue Doppler imaging derived MPI and E/e’ ratio parameters by echocardiography and these parameters could also use as markers of trastuzumab toxicity in this population.

Effect of Radiotheraphy on Impaired Aortic Elasticity and Stiffness in Patients With Breast Cancer

We evaluated the effect of radiotherapy (RT) on the elastic properties of the aorta using echocardiography in patients with breast cancer (BC). A total of 105 women with left-sided epidermal growth factor receptor 2 (erb-2) BC were divided into 2 groups, group 1 with patients who did not receive RT and group 2 with patients who received RT. In all patients, echocardiographic examination and serum high-sensitivity C-reactive protein (hs-CRP) levels were determined. A significant decrease in aortic distensibility (AD) and increase in hs-CRP were seen from group 1 to group 2. The AD was inversely correlated with left ventricle diastolic diameter, systolic blood pressure (SBP), left atrial diameter, age, and RT dose. The AD was significantly related to age, SBP, and RT dose. Increased RT dose is significantly correlated with impaired elastic properties that may contribute to the relation of RT and increased rate of cardiovascular events among patients with BC who received RT.

Treatment of an unusual complication of transfemoral TAVI with a new technique : successful occlusion of ventricular septal defect by opening the closure device in the ascending aorta : case report

Ventricular septal defect (VSD) is a rare complication of transcatheter aortic valve implantation (TAVI) via the transfemoral approach. Aetiological factors leading to VSD have been reported as post-balloon dilatation, oversized prosthesis implantation, and severe calcification of the aorta. However, we present a case of VSD occurring after TAVI with an Edwards Sapien XT prosthesis without any distinct aetiological factors. We used a new technique for closure of the significant VSD; opening the left ventricular disc of the closure device in the ascending aorta and successfully implanting the device without any damage to the bioprosthetic valve.

Arterial stiffness and dipper/nondipper blood pressure status in women with preeclampsia

IntroductionThe aim of this study was to investigate the clinical relevance of dipper status in women with preeclampsia by comparing arterial stiffness index (SI) values, and dipper and nondipper status.MethodsA total of 60 pregnant women in their third trimester were enrolled in the study. SI values were measured using a digital photoplethysmographic method (Pulse Trace System, Micro Medical Ltd., Gillingham, Kent, UK). Twenty-four-hour ambulatory blood pressure was measured by a SpaceLabs 90217 oscillometric device (SpaceLabs Inc., Redmond, WA, USA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were recorded. Those preeclamptic women whose mean nighttime blood pressure measurements were at least 10% lower compared with mean daytime measurements were classified as dipper status, and those with a decrease of less than 10% were classified as nondipper status.ResultsSeventeen women were preeclamptic with a dipper status, 13 women had nondipper status preeclampsia, and 30 women were normotensive. SI values were significantly higher in preeclamptic women compared with normotensive women (8.8±1.2 m/s vs. 5.9±0.8 m/s, P<0.001), but SI values of preeclamptic women with dipper status and preeclamptic women with nondipper status did not differ significantly from each other (P=0.485).ConclusionThere was no significant difference in SI values between the dipper and nondipper preeclamptic groups. These results indicate that dipper and nondipper measurements may not be suitable for clinical follow-up of preeclamptic women.

GuideLiner catheter application in complex coronary lesions: experience of two centers

Objective: GuideLiner catheter provides adequate back-up support and a coaxial guide engagement for stent delivery in complex coronary anatomies. In this study, we aimed to present one of the largest series of experience with GuideLiner catheter utilized for challenging percutaneous coronary interventions in two centers. Methods: We retrospectively collected the coronary angiography records of 64 patients between January 1, 2012 and August 1, 2014 in whom conventional techniques failed for stent delivery and 5-in-6 Fr GuideLiner catheter was used for this purpose. The data were assessed in terms of the lesion characteristics, procedural success, and complications. Descriptive statistics and frequencies were used in statistical analyses. Results: The mean age of the patients was 69.8±10.0 years. Femoral approach was employed in all cases. Lesions were mostly (90.6%) class B2 or C according to the AHA/ACC lesion classification. The GuideLiner catheter was mainly used to increase back-up of the guide catheter (85.9%), and in 95.3% of all cases, the procedure was successful. The mean depth of the GuideLiner catheter intubation was 30.3±21.6 mm. None of the patients had coronary dissection or major complications. Conclusion: In this study, we presented a large registry of two centers used the GuideLiner catheter. The device effectively allowed stent delivery in challenging lesions, where conventional techniques have failed, without major complications.

The relationship between neutrophil to lymphocyte ratio and blood pressure variability in hypertensive and normotensive subjecs.

OBJECTIVES Blood pressure (BP) variability is associated with hypertensive (HT) target organ damage and cardiovascular events. The aim of this study was to investigate the relation between neutrophil to lymphocyte ratio (NLR) and BP variability in hypertensive and normotensive subjects. STUDY DESIGN In this cross-sectional study, 150 subjects (63 male, mean age 52.1±5.2 years) were enrolled. In all patients, blood samples and 24-hour ambulatory blood pressure (BP) monitoring were obtained. According to 24-hour ambulatory BP results, participants were divided into four investigation categories. Group 1= Normotensive dipper (ND), Group 2= Normotensive non-dipper (NN), Group 3= HT dipper (HD), Group 4= HT non-dipper (HN). RESULTS Highest NLR values were determined in the HN group (p=0.005 vs. ND, p=0.046 vs. NN and p<0.01 vs. HD). NLR values were similar among the ND, NN and HD groups (p>0.05, for all). NLR was correlated with night systolic blood pressure (SBP) (r=0.178, p=0.031), night diastolic blood pressure (DBP) (r=0.176, p=0.032) and BP variation rate (r=-0.246, p=0.003). Multiple linear regression analysis showed BP variation rate to be an independent predictor of high NLR value (ß=0.186, 95% CI=0.918-0.982, p=0.044). In ROC analysis, a level of NLR>2.7 predicted non-dipper HT with 83% sensitivity and 65% specificity (ROC area under curve: 0.653, 95% CI=0.565-0.741, p=0.001). CONCLUSION In the present study, we found that NLR levels were significantly correlated with BP variability. The measurement of NLR may be used to indicate increased risk of HT-related adverse cardiovascular events.

The relationship between red-cell distribution width and abnormal left ventricle geometric patterns in patients with untreated essential hypertension

Abnormal left ventricle (LV) geometric patterns are associated with an increased risk of vascular complications of hypertension (HT). The association between red-cell distribution width (RDW) and HT has been recently investigated; however, the relationship between abnormal LV geometric patterns and RDW has not been studied before. The aim of this study was to investigate the relationship between RDW and abnormal LV geometric patterns in patients with untreated essential HT. Measurements were obtained from 139 patients with untreated essential HT (mean age=51.3±16.3 years). Four different geometric patterns (NG, normal geometry; CR, concentric remodeling; EH, eccentric hypertrophy; CH, concentric hypertrophy) were determined according to the LV mass index (LVMI) and relative wall thickness (RWT). RDW, lipid parameters and other biochemical markers were measured in all patients. While the highest RDW values were detected in the CH group (P<0.05, for all), it was similar among the NG, CR and EH groups (P>0.05, for all). RDW was associated with age, LVMI and LV geometry in bivariate analysis (P<0.05, for all). In a receiver operating characteristic (ROC) curve analysis, a level of RDW>14.5 predicted CH with 81% sensitivity and 59% specificity. Age (beta=0.309, P=0.001), LV geometry type (beta=0.228, P=0.01) and RWT (beta=−0.278; P=0.25) were independent predictors of high RDW in multiple linear regression analysis. In conclusion, the highest RDW values were observed in the CH group in the untreated essential HT patients. RDW seems to be a useful tool for the prediction of end-organ damage in patients with untreated essential HT.

The Relationship between Neutrophil-To-Lymphocyte Ratio and Fragmented QRS in Acute STEMI Patients Treated with Primary PCI ☆ ☆☆

BACKGROUND No study so far investigated fragmented QRS (fQRS) and neutrophil-to-lymphocyte ratio (NLR) together in ST segment elevation myocardial infarction (STEMI). OBJECTIVE To investigate the relationship between NLR and fQRS, and determine the prognostic significance of the combined use of these two parameters in STEMI. METHODS We included 368 patients with first acute STEMI who successfully revascularized with primary percutaneous coronary intervention. RESULTS Patients with fQRS had significantly higher NLR, and in-hospital mortality rate compared to patients with no-fQRS. The best cut-off value of NLR to predict mortality was 5.47. Patients with NLR≥5.47 had a higher frequency of fQRS and in-hospital mortality rate. Multivariate analysis showed that NLR was an independent predictor of the presence of fQRS (OR: 1.095, 95% CI: 1.039-1.153, P=0.001). When patients were stratified by fQRS and cut-off value of NLR, in-hospital mortality gradually increased (P<0.001). CONCLUSION NLR is independently associated with the presence of fQRS in STEMI patients. Combined use of both parameters provides additional prognostic contribution for identifying patients at higher cardiac risk.

TAVI in a Patient with Single Coronary Artery: The Choice of Self-Expandable Valve may be Reasonable.

BACKGROUND Single coronary artery is a rare congenital coronary artery anomaly with the incidence of approximately 0.03%-0.05%. Its coexistence with severe aortic stenosis (AS) is even rarer. Patients who undergo transcatheter aortic valve implantation (TAVI) have a risk of coronary obstruction (1%) which will be more lethal when the origin of the coronary artery is single. CASE REPORT An 81 year-old female was referred to our institution for severe AS. Her coronary angiography revealed a single coronary artery originating from right sinus of valsalva. Since the patient had a high risk for aortic valve surgery, the cardiac team decided to perform transfemoral TAVI with a self-expandable valve. CONCLUSION We presented a successful case of TAVI with Medtronic CoreValve (Medtronic; Minnesota, USA) in a patient with single coronary artery after discussing the base of our strategy for preferring self-expandable valve. To the best of our knowledge, this is the second case of CoreValve implantation in such a patient in the literature. We suggest that the self-expandable valve may be the first choice in these patients because of its recapturable design.

Single Derivation Fragmented QRS Can Predict Poor Prognosis in Successfully Revascularized Acute STEMI Patients

Background QRS fragmentation (fQRS) is classically defined as the presence of slurred QRS morphology in at least two contiguous leads, and its prognostic importance has been shown in ST elevation myocardial infarction (STEMI). However, no study has investigated the significance of single lead fQRS (sl-fQRS) in surface electrocardiography (ECG). Objectives To evaluate whether sl-fQRS is as valuable as classical fQRS in patients with acute STEMI who had successful revascularization with primary percutaneous coronary intervention (pPCI). Methods We included 330 patients with a first STEMI who had been successfully revascularized with pPCI. The patient’s electrocardiography was obtained in the first 48 hours, and the patients were divided into three groups according to the absence of fQRS (no-fQRS); fQRS presence in a single lead (sl-fQRS); and ≥2 leads with fQRS (classical fQRS). Results In-hospital mortality was significantly higher both in patients with sl-fQRS and in patients with ≥ 2 leads with fQRS compared to patients with no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a sensitivity of 75% and specificity of 57.4% for the prediction of in-hospital mortality. Multivariate analysis showed that sl-fQRS is an independent predictor of in-hospital mortality (OR: 3.989, 95% CI: 1.237-12.869, p = 0.021). Conclusions Although the concept of at least two derivations is mentioned for the classical definition of fQRS, our study showed that fQRS in only one lead is also associated with poor outcomes. Therefore, ≥1 leads with fQRS can be useful when describing the patients under high cardiac risk in acute STEMI.