Meryem Kara

Change in left ventricular systolic function in patients with ST elevation myocardial infarction: Evidence for smoker's paradox or pseudo-paradox?

Background The ‘smokers paradox’ refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI). Objective Aim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI. Methods Our population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined. Results Basal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95 ± 7.93% vs. 40.32 ± 7.28%; p = 0.011); it worsened in smokers at follow-up (mean decrease in LVEF: −2.70 ± 5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97 ± 8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF. Conclusion True or persistent ‘smokers paradox’ does not appear to be relevant among STEMI patients undergoing p-PCI. The ‘smokers paradox’ is in fact a pseudo-paradox. Further studies with larger numbers may be warranted.

Manual heating of the radial artery (Balbay maneuver) to facilitate radial puncture prior to transradial coronary catheterization

OBJECTIVE Transradial access is widely used for both diagnostic and interventional cardiac procedures. The use of transradial access offers several advantages, including decreased bleeding, fewer vascular complications, and reduced length of hospital stay and cost. However, the small size of the radial artery limits the size of the equipment that can be used via this approach. In this study we sought to investigate whether preprocedural manual heating of the radial artery facilitates radial artery puncture. METHODS Patients undergoing transradial cardiac catheterization were randomized to subcutaneous nitroglycerin plus diltiazem or manual heating. The study endpoint was puncture score (score 1: easiest - puncture at first attempt; score 2: second attempt; score 3: third attempt; score 4: fourth attempt or more; score 5: puncture failed). RESULTS Ninety consecutive patients were enrolled in the study, 45 allocated to the drug treatment group and 45 to the heating group. Patients underwent radial artery ultrasound before catheterization. Complications were rare: one hematoma (drug treatment group) and one radial artery occlusion (heating group). Baseline demographic and clinical characteristics were similar. Baseline radial artery diameter was similar in both groups (2.41±0.46 mm and 2.29±0.48 mm in the heating and drug treatment groups, respectively). However, the median puncture score was lower in the heating group (1; interquartile range 1-2) compared to the drug treatment group (2; interquartile range 1-3; p=0.001). CONCLUSIONS Preprocedural manual heating of the radial artery facilitates radial artery puncture in patients undergoing transradial cardiac catheterization.

Parameters influencing the physical activity of patients with a history of coronary revascularization

INTRODUCTION AND OBJECTIVE Coronary artery disease is the leading cause of mortality worldwide. Regular physical activity is part of a comprehensive management strategy for these patients. We investigated the parameters that influence physical activity in patients with a history of coronary revascularization. METHODS We included outpatients with a history of coronary revascularization at least six months prior to enrollment. Data on physical activity, demographics, and clinical characteristics were collected via a questionnaire. RESULTS A total of 202 consecutive outpatients (age 61.3±11.2 years, 73% male) were enrolled. One hundred and four (51%) patients had previous percutaneous coronary intervention, 67 (33%) had coronary bypass graft surgery, and 31 (15%) had both procedures. Only 46 patients (23%) engaged in regular physical activity. Patients were classified into two subgroups according to their physical activity. There were no significant differences between subgroups in terms of age, comorbid conditions or revascularization type. Multivariate regression analysis revealed that low education level (OR=3.26, 95% CI: 1.31-8.11, p=0.01), and lack of regular follow-up (OR=2.95, 95% CI: 1.01-8.61, p=0.04) were independent predictors of non-adherence to regular physical activity among study subjects. CONCLUSIONS Regular exercise rates were lower in outpatients with previous coronary revascularization. Education level and regular follow-up visits were associated with adherence to physical activity in these patients.

The short-term impact of the catheter ablation on noninvasive autonomic nervous system parameters in patients with paroxysmal atrial fibrillation: KUYUMCU et al.

The autonomic nervous system (ANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF), whereas the presence of AF can activate and alter the ANS. The catheter ablation of AF (AFCA) may cause the cardiac ANS dysfunction, whereas restoration of sinus rhythm or sympathovagal imbalance by AFCA can reverse this process. Our principal goal was to investigate the short‐term effect of AFCA on ANS functions evaluated by noninvasive chronotropic (CI), resting heart rate (RHR), and heart rate recovery (HRR) indices.

The association between mean platelet volume and spontaneous echocardiographic contrast or left atrial thrombus in patients with mitral stenosis

Objective: Although the role of platelet activation has been debated in patients with mitral stenosis (MS) and spontaneous echocardiographic contrast (SEC), data on differences in mean platelet volume (MPV) according to the presence of SEC/left atrial thrombus and the rhythm status are lacking. In this study, MPV was analyzed in patients with MS according to the presence of SEC/left atrial thrombus. Methods: Between January 2005 and March 2014, 188 symptomatic patients having moderate or severe MS (mean age, 45.0±11.7 years; female, 81.4%) with favorable valve morphology for percutaneous mitral balloon valvuloplasty (PMBV) and underwent a transesophageal echocardiogram to assess the eligibility for PMBV were retrospectively enrolled in the study. The relation between MPV and echocardiographic thromboembolic risk factors were evaluated. Independent predictors of SEC/left atrial thrombus presence were determined by multiple logistic regression analyses. Results: Among all patients, MPV did not differ according to the rhythm status or the presence of SEC/left atrial thrombus (p>0.05). Also, MPV did not vary according to the gender and presence of prior stroke in both atrial fibrillation and sinus rhythm groups (p>0.05). In correlation analysis, MPV did not show any significant correlation with the echocardiographic thrombus predictors (p>0.05). Conclusion: Using MPV with echocardiographic and clinical thrombus risk determinants for predicting individual thromboembolism risk in MS is debatable according to our results.

Usefulness of the Macruz Index for Predicting Successful Percutaneous Mitral Balloon Valvuloplasty in Patients with Mitral Stenosis

Objective: The aim of this study was to determine whether the Macruz index (P/P-R segment) could predict the severity of valvular involvement and the success of percutaneous mitral balloon valvuloplasty (PMBV) in patients with mitral stenosis (MS). Subjects and Methods: Sixty-one patients with MS eligible for PMBV and 72 healthy subjects (61 females and 11 males) with sinus rhythm were enrolled into this study. PMBV was performed in all patients using a percutaneous transseptal antegrade approach and a multitrack balloon technique. The P/P-R segment ratio and echocardiographic variables were measured before and 48-72 h after the procedure. The optimal cutoff point for differences in the Macruz index to determine clinical success was evaluated by receiver operating characteristic analysis by calculating the area under the curve as giving the maximum sum of sensitivity and specificity for the significant test. Results: In the patient group (mean age 42.9 ± 11.1 years), the preprocedural Macruz index was significantly higher than in the control group (2.79 ± 1.03 vs. 1.29 ± 0.11; p < 0.001). In the successful-procedure group (n = 53), the mean postindex value was significantly lower (2.12 ± 0.71 vs. 2.81 ± 1.0, p = 0.020), and the decrease in the Macruz index was significantly higher than in the unsuccessful-procedure group (p = 0.007). An index decrease of 0.105 was the best cutoff value to distinguish the successful-PMBV group from the unsuccessful- PMBV group (area under the curve = 0.888, 95% confidence interval 0.788-0.988, p < 0.001). Conclusion: The Macruz index was significantly higher in patients with MS compared to healthy subjects. A greater decrease in the Macruz index was associated with a successful PMBV.

Inadvertent puncture of the aortic noncoronary cusp during postoperative left atrial tachycardia ablation

Transseptal catheterization has become part of the interventional electrophysiologists technical armamentarium since the development of left atrial catheter ablation and percutaneous technologies for treating mitral and aortic valve disease. Although frequently performed, the procedures most feared complication is aortic root penetration. Focal atrial tachycardia has been described as the most common late sequela of surgical valve replacements. We present a complicated case involving the inadvertent delivery of an 8 French sheath across the noncoronary cusp during radiofrequency catheter ablation for left atrial tachycardia originating from the mitral annulus in a patient with prior mitral valve replacement.