Lütfü Bekar

Investigation of mindin levels in hypertensive patients with left ventricular hypertrophy and QRS fragmentation on electrocardiography

Abstract Purpose: Mindin was associated with diabetic nephropathy, podocyte injury, colitis, allergic asthma, liver ischaemia and reperpusion injury and ischaemic brain injury. On the other hand, it was reported as a protective factor against obesity, cardiac hypertrophy, fibrosis and remodelling. Fragmented QRS complexes (fQRS) are markers of altered ventricular depolarisation owing to a prior myocardial scar and fibrosis. In this study, we aimed to investigate mindin levels in hypertensive patients with left ventricular hypertrophy and fQRS on electrocardiography. Methods: This observational case-control study enrolled 70 (36 female) hypertensive patients with fQRS and 38 (23 female) hypertensive control patients. All patients were evaluated by transthoracic echocardiography. Mindin levels were measured by the enzyme-linked immunosorbent assay (ELISA). Clinical, echocardiographic and laboratory data were compared between patient and control groups. Results: There was no significant difference between patient and control groups in terms of clinical, echocardiographic and routine laboratory parameters. The mindin levels were significantly higher in the patient group than controls (11.3 (7.21–19.31) vs 4.15 (2.86–6.34); p < .001). Multiple logistic regression analyses defined increased mindin levels as an independent predictor for the presence of fQRS (Odds ratio: 1.733; p = .034). Mindin levels >6.74 predicted the presence of fQRS with a sensitifity of 84.3% and specificity of 79.9% on receiver operating characteristic (ROC) curve analysis (The area under the curve:0.889; Confidence Interval: 0.827–0.951; p < .001). Conclusion: Mindin expressin is upregulated in hypertensive patients with fQRS complexes. In contrary to previous studies, increased mindin levels may be associated with myocardial fibrosis.

A rare Congenital Coronary Artery Anomaly: Woven Right Coronary Artery associated with Myocardial Infarction

Woven coronary artery (WCA) is an extremely rare and still not a clearly de ined coronary anomaly. It is characterized by the division of epicardial coronary artery into thin channels which then reanastomose with the distal part of the abnormal coronary artery [1]. Since the angiographic imaging of WCA looks like an intracoronary thrombus and dissection; the differential diagnosis between atherothrombotic coronary arteries with recanalization of organized thrombi in coronary arteries and WCA may be very dif icult for invasive cardiologists, especially in patients with single or two coronary artery involvements [2].

Spontaneous rupture of a giant Coronary Artery Aneurysm after acute Myocardial Infarction

Coronary artery aneurysm is commonly de ined as a localized dilatation exceeding the diameter of adjacent normal coronary segments by 50% [1]. Coronary artery aneurysms may be fusiform, involving the full circumference of the coronary artery, or saccular, involving only a portion of the circumference [2]. Causes of coronary artery aneurysms include atherosclerosis (accounting for 50% of cases), Kawasaki disease, polyarteritis nodosa, infection, trauma, coronary dissection, percutaneous coronary angioplasty, and congenital malformations [3]. The abnormal blood low within the coronary artery aneurysm may lead to thrombus formation, embolization, rupture, myocardial ischemia or myocardial infarction [4]. Here we present a case of a giant fusiform coronary artery aneurysm who passed away due to coronary rupture after acute myocardial infarction.

Left atrial compression.

Answer: p. 312 A 55-years old male patient presented to our clinic with the complaint of atypical chest pain. On the physical examination; blood pressure was 110/70 mm Hg, heart rate was 70/min with sinus rhythm without murmur. On echocardiographic examination ejection fraction (EF) was 62% and there were no other cardiac or valvular abnormalities. There was a large echolucent cystic mass compressing the left atrium (Fig. 1, Video 1. See correspondening video/movie images at www.anakarder.com). Chest computed tomography (CT) revealed a large mass with a maximum diameter of 4.8 cm compressing the left atrium (Fig. 2). Based on these findings, we diagnosed the lesion as a cystic mass causing a sensation of heaviness in the chest, and considered the patient to be a candidate for surgery.

Lev’s disease: insidious enemy of conduction system

A 60-year-old previously hypertensive gentlemen presented with progressive dyspnea. Electrocardiography showed atrial fibrillation with left bundle branch block. Cardiac catheterization revealed normal coronary arteries, severe aortic and mitral regurgitation. Despite mild calcification of aortic valve we noted a band-like calcification arising from aortic valve, extending into and outlining the bundle of His, and probably proximal part of the left bundle (Fig. 1, 2, Video 1. See corresponding video/movie images at www.anakarder.com). Lev’s disease is often accompanied by aortic valve calcification that may invade the bundle of His, the right and/or left bundle branch. Progressive loss of myocytes lead to conduction defects including atrioventricular and bundle branch blocks. Fatih Altunkaş, Orhan Önalan, Lütfü Bekar, Köksal Ceyhan Department of Cardiology, Faculty of Medicine, Gaziosmanpaşa University , Tokat, Turkey