Murat Meric

Efficiency of atorvastatin in the protection of anthracycline-induced cardiomyopathy.

To the Editor: Antineoplastic agents of the anthracycline (ANT) group are commonly and effectively used in various forms of malignancies. Anthracyclines might lead to irreversible cardiomyopathy (CMP), despite their beneficial effects. A number of mechanisms, such as elevation in free superoxide

Late pacemaker twiddler syndrome

Dr. Ihsan Dursun, MD ()) · Prof. Osman Yesildag, FESC Korhan Soylu, MD · Prof. Ozcan Yilmaz · Erdogan Yasar, Tech Murat Meric, MD Ondokuz Mayis Universitesi Tip Fakultesi, Kardiyoloji Bolumu 55139 Kurupelit Samsun/Turkey Tel.: 90-5 32 / 4 30 87 62 Fax: 90-3 62 / 4 57 60 41 E-Mail: ihsandursun@mynet.com Sirs: Twiddler syndrome, known as the rolling up of the pacemaker battery within the pacemaker pocket, was first described in 1968 by Bayliss et al. [1]. Frequently, twisting of the pacemaker battery within the pacemaker pocket ends with the dislocation of the electrode, diaphragmatic stimulation and the loss of capture [2]. This situation is not limited to only cardiac pacemaker batteries. It has also been observed in implantable cardioverter defibrillators [3]. Symptoms begin with the twisting of the pacemaker battery within the pacemaker pocket in which it is implanted. The capture problem is a result of the dislocation of the electrode. Hypoperfusion symptoms such as fatigue, tiredness, confusion, presyncope and syncope can be observed if the patient is completely dependent on the cardiac pacemaker [4]. Except the symptoms related with the failure of the cardiac pacemaker, other symptoms are also observed frequently as well due to the damage of the neigbouring organs. Ipsilateral phrenic nerve stimulation concludes the sensation of the diaphragmatic and abdominal pulsations. Additionally, if the electrodes become more twisted around the battery, rhythmic arm movements can occur due to the stimulation of the brachial plexus [5]. However not all cases display clinical symptoms [3]. Capture or pace problems can also be observed in the electrocardiography (ECG). The ECG is also abnormal if the electrode dislocates intermittently. On a chest X-ray, the electrodes can be seen as bent, twisted or dislocated and fractured [4].

The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention

PURPOSE It has been known that inflammatory mechanisms play an important role in the coronary artery disease. Our aim in this study was to investigate the relationship between the neutrophil/lymphocyte (N/L) ratio and coronary flow velocity after primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS Two hundred and ten patients who had undergone primary PCI were included. The coronary flow velocities were evaluated using the recorded PCI procedures by Thrombolysis in Myocardial Infarction (TIMI) flow grades and corrected TIMI frame counts (cTFC) values. A value of >40 for the final cTFC was accepted as an index of insufficient coronary blood flow. The white blood cell subtypes and counts were determined in the blood samples obtained at the clinics. RESULTS In 165 (78%) of the investigated patients, reperfusion was found to be sufficient (Group I) while in 45 (22%) of them (Group II) insufficient reperfusion was observed (Group II). In-hospital mortality was 7.2% (n=12) in Group I, whereas it was 17.7% (n=8) in Group II (P=0.033). Similarly, one-year mortality was higher in Group II (26.6%, n=12) than in Group I (13.3%, n=22) (P=0.031). N/L ratio was determined to be higher in Group I than in Group II (8.3±6.1 vs. 6.2±5.0; P=0.034). Also, N/L ratio was found as an independent predictor of severe no-reflow development (TIMI 0-1) and of one-year mortality (P=0.01 and P=0.047, respectively). CONCLUSIONS N/L ratio has been found to be an independent indicator for no-reflow development in patients who have undergone PCI for acute STEMI. This simple and low-cost parameter can provide useful information for the relevant risk evaluation in these patients.

Evaluation of the Relationship Between Arterial Blood Pressure, Aortic Stiffness and Serum Endothelin-1 Levels in Patients with Essential Hypertension

This study has attempted to evaluate the relationship between aortic stiffness, blood pressure (BP) and serum endothelin-1 (ET-1) levels in patients with essential HT. Totally 152 subjects, consisting of 103 patients diagnosed with HT at least 1 year previously and 49 healthy individuals, were enrolled in this study. They were subdivided, on the basis of BP measurements made at home, into three groups as the hypertensives with dysregulated BP (n = 56), the hypertensives with regulated BP (n = 47) and the normotensive controls (n = 49). Statistically significant differences were observed between the three groups with respect to aortic elasticity parameters (p < 0.01 for aortic strain, aortic distensibility and aortic stiffness). Serum ET-1 levels in the three groups were similar (p = 0.101), but a significant correlation was observed between the ET-1 values and the aortic elasticity parameters (p = 0.004). Alteration of the aortic elasticity parameters in patients with HT not only correlates with the serum ET-1 levels indicating endothelial dysfunction but also gives direct clues about status of BP regulation.

Woven Right Coronary Artery

Abstract  Woven coronary artery is characterized by the twisting course of multiple thin channels along the vessel in any coronary artery with a TIMI‐III blood flow. It is an extremely rare coronary anomaly, which is generally considered to be benign. We present a 48‐year‐old male patient with a woven coronary artery anomaly with a right woven who presented with a myocardial infarction and review the literature on this coronary anomaly. (J Card Surg 2012;27:345‐346)

Evaluation of plasma chemerin levels in patients with non-dipper blood pressure patterns

Background Chemerin is a novel adipokine that plays a role in inflammation and atherosclerosis. Although there are several correlations between hypertension and the inflammatory system, there is still insufficient information about the relationship between blood pressure variability and inflammatory markers. In this study, we aimed to determine whether chemerin levels are elevated in non-dipper patients compared with dippers and healthy controls. Material/Methods This study was composed of a group of 90 patients: 60 hypertensive patients and 30 healthy control subjects (12 males, mean age 53.2±15.4 years). Ambulatory blood pressure monitoring devices (ABPM) were connected to all patients. Using data from the ABPM, hypertensive patients were divided into 2 groups: 30 dipper patients (12 males, mean age 52.5±15.1 years) and 30 non-dipper patients (11 males, mean age 54.6±13.0 years). Complete blood count and biochemistry were measured by standard methods and plasma chemerin concentrations were quantified by ELISA. Results Non-dipper patients demonstrated higher chemerin levels compared to dippers and normotensives (219.7±16.3 vs. 182.4±21.4 ng/ml; 219.7±16.3 vs. 85.4±38.1 ng/ml, respectively, p<0.001 for both comparisons). A receiver operating characteristic curve analysis revealed that the optimal cut-off value for chemerin to predict a non-dipping pattern was 201.4, with 90% sensitivity and 90% specificity. There was a positive correlation between chemerin levels and all ambulatory blood pressure values in all hypertensive patients. Conclusions Chemerin, which plays a role in inflammation and atherosclerosis, was higher in non-dippers compared to dippers and normotensives. Additionally, chemerin shows positive correlations with blood pressure.

A multicentre, comparative study of Cera septal occluder versus AMPLATZER Septal Occluder in transcatheter closure of secundum atrial septal defects

AIMS To evaluate the safety and efficacy of the new Cera septal occluder (CSO) for atrial septal defect (ASD) closure as compared to the AMPLATZER Septal Occluder (ASO). METHODS AND RESULTS A total of 405 ASD patients receiving CSO or ASO were studied. The ASDs were classified into simple defects (isolated defects <26 mm) or complex defects (isolated defects ≥26 mm, large defects with a deficient rim, double or multi-fenestrated defects). Clinical and echocardiographic findings were collected before discharge, at one month, and every six months after implantation. Two hundred and five (133 females, aged 30±13 years) and 200 (135 females, aged 28±14 years) patients received CSO and ASO implants, respectively. The CSO group had similar ASD and device sizes, prevalence of complex lesions, procedural times and success rates as compared to the ASO group. Echocardiographic follow-up at one and six months showed similar residual shunts between devices. Both groups had similar rates for device embolisation and atrial arrhythmia. The average equipment cost per patient was lower in the CSO group than in the ASO group (US

The role of heart-type fatty acid-binding protein in the evaluation of carbon monoxide poisoning in rats

3,500 vs. US

Single coronary artery: right coronary artery originated from middle of left anterior descending artery in a patient with severe mitral regurgitation.

5,600, p<0.001). CONCLUSIONS Transcatheter ASD closure with CSO is safe and effective. It appears to be an attractive alternative to ASO because of its relatively low cost.

Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon: A Study of Speckle Tracking Echocardiography

Acute carbon monoxide (CO) poisoning can cause early and persistent damages in tissues sensitive to hypoxia. This study investigated serum heart-type fatty acid-binding protein (H-FABP) levels as a biomarker of acute CO poisoning in rats. The rats were exposed to a mixture of either 3000 (group A) or 5000 (group B) parts per million (ppm) CO in air, or to ambient air (group C, control group). Blood samples were taken just before, immediately after and 6 hours after the exposure, and serum H-FABP and troponin-I levels were measured. The consciousness level was evaluated just after the exposure. The survival rate was monitored for 7 days. Serum H-FABP levels increased just after the CO exposure in both groups A and B. Additionally, H-FABP level was higher in group B than in group A, immediately after the exposure. However, serum troponin-I levels only increased at 6 hours after the CO exposure in groups A and B. Consciousness and survival rates in group B were lower than that in group A. Our results suggest that H-FABP might have potential to be an early and quantitative parameter of clinical severity and prognosis in CO poisoning.