Murat Uğurlu

Effect of Hematologic Parameters on Microvascular Reperfusion in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.

Objectives: Despite the significant role of certain hematologic parameters in reperfusion injury, their relationship with microvascular reperfusion remains not well understood. Therefore, our objective was to evaluate the relationship between hematologic parameters at admission and microvascular reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (primary PCI). Methods: A total of 213patients (mean age: 57.5 ± 11 years) with STEMI were included. Blood samples were obtained from all patients prior to primary PCI. Electrocardiographic recordings were made for the evaluation of ST-segment resolution (STR) before and after primary PCI. Angiographic assessment in the infarct-related artery was performed using the myocardial blush grade (MBG) and thrombolysis in myocardial infarction (TIMI) flow. Patients were categorized into 2 groups as those with impaired microvascular reperfusion (STR <70%, TIMI: 0-1, and MBG: 0-1) and those with normal microvascular reperfusion (STR >70%, TIMI: 2-3, and MBG: 2-3). Results: Of the overall study group, 139, 105, and 69 patients had an STR of <70%, MBG of 0-1, and TIMI of 0-1, respectively. Demographic parameters in both groups are shown in the tables. Patients with impaired microvascular reperfusion were found to have higher white blood cell (WBC) count, neutrophil count, lymphocyte count, and mean platelet volume (MPV). Neutrophil–lymphocyte ratio and platelet count were similar between the 2 groups. Correlation analysis showed a negative correlation between lymphocyte count and STR (r: −.195, P: .004), lymphocyte count and TIMI flow(r: −.09, P: .14), and lymphocyte count and MBG (r: −.211, P: .002). Conclusion: Our results suggest that higher WBC count and MPV at admission are independent predictors of impaired microvascular perfusion in patients with STEMI. On the other hand, a negative correlation was found between lymphocyte count and impaired microvascular perfusion. Specifically, elevated lymphocyte count seemed to indicate the presence of impaired microvascular reperfusion in patients with STEMI.

QRS duration: a novel marker of microvascular reperfusion as assessed by myocardial blush grade in ST elevation myocardial infarction patients undergoing a primary percutaneous intervention.

ObjectivesProlonged QRS duration is a predictor of poor prognosis in patients with coronary artery disease. The association between the duration of QRS and myocardial reperfusion is not very well understood. Our aim was to assess the relationship between the measurements of QRS duration and myocardial blush grade (MBG) in patients with ST elevation myocardial infarction (STEMI) who were treated with a primary percutaneous intervention. Patients and methodsA total of 213 patients (mean age: 57.5±11 years) with STEMI were included. ECG recordings were obtained for the evaluation of the QRS duration before and after primary percutaneous coronary intervention. Angiographic assessment in the infarct-related artery was performed using the MBG. Patients were categorized into two groups of those with impaired microvascular reperfusion (MBG: 0–1) and those with normal microvascular reperfusion (MBG: 2–3). ResultsOverall, 105 and 108 patients had an MBG of 0–1 or 2–3, respectively. There is no significant difference between patient’s characteristics. Despite the absence of a difference between two groups in terms of the QRS duration at presentation (P: 0.57), patients with impaired microvascular reperfusion were found to have longer QRS duration at immediately postprocedure (P: 0.003) and postprocedure 60 min time-points (P<0.001). Correlation analyses showed a positive correlation between pain-to-balloon time and QRS duration at postprocedure 60 min time-points (r: 0.137 and P: 0.04). ConclusionOur results suggest that longer QRS duration after angioplasty seemed to indicate the presence of impaired microvascular reperfusion in patients with STEMI.

Relation between Apolipoprotein E Gene Polymorphism and Severity of Coronary Artery Disease in Acute Myocardial Infarction.

Apolipoprotein E (ApoE) is a plasma protein and associated with cholesterol transport system. In several studies, the relationship between ApoE gene polymorphism and severity of coronary artery disease (CAD) has been shown. However, the relationship between ApoE gene polymorphism and severity of CAD in patients with acute myocardial infarction (MI) has not been well known. The aim of this study is to investigate the relation between ApoE polymorphism and severity of CAD in patients with acute MI by using the Gensini Score. In this study, 138 patients were admitted to cardiology clinic with diagnosis of acute MI, and angiographic assessment was performed using the Gensini Score. Blood samples were obtained from all patients in the first day. The patients with ApoE34 genotype had high Gensini scores. Besides, the patients with E4 allele carriers were associated with high Gensini score compared with the patients without E4 allele carriers (p:0,22). The patients with E4 allele carriers were associated with higher LDL cholesterol and total cholesterol compared with the patients without E4 allele carriers (p:0,001 and p:0,03, resp.). There were no statistically significant differences between ApoE genotypes and severity of CAD by using the Gensini Score. But, the patients with E4 allele carriers were associated with high lipid levels.

Association Between ACE Gene Polymorphism and QT Dispersion in Patients with Acute Myocardial Infarction

Background: Angiotensin converting enzyme (ACE) gene polymorphism is associated with high renin-angiotensin system causing myocardial fibrosis and ventricular repolarization abnormality. Based on these findings, this study was designed to determine the association between ACE gene insertion/deletion (I/D) polymorphism and QT dispersion after acute myocardial infarction (MI). Objective and Methods: The study included 108 patients with acute MI. Blood samples were obtained from all the patients for genomic DNA analysis. ECGs were recorded at baseline and at the end of a 6-month follow up. The OT dispersion was manually calculated. Results: The mean age of the patients was 57.5 ±9.9 years (ranging from 36 to 70). The patients with DD genotype showed longer QT dispersion than patients with II or DI genotype at the baseline, while at the end of the six-month follow up the patients with DI genotype showed longer QT dispersion than patients with DD or II genotypes. However, the magnitude of the QT dispersion prolongation was higher in patients carrying the ACE D allele than patients who were not carrying it, at baseline and at the end of six-month follow up (52.5 ±2.6 msn vs. 47.5±2.1 msn at baseline, 57±3.2 msn vs. 53±2.6 msn in months, P: 0.428 and P: 0.613, respectively). Conclusion: Carriers of the D allele of ACE gene I/D polymorphism may be associated with QT dispersion prolongation in patients with MI.An interaction of QT dispersion and ACE gene polymorphism may be associated with an elevation of serum type I-C terminal pro-collagen concentration, possibly leading to myocardial fibrosis, and increased action potential duration.

Very Unusual Case Report: Type RIII of Lipton's Classification

Single coronary artery is a very rare congenital anomaly in the general population. We presented a 51 year-old male with typical chest pain, and coronary angiogram showed a single trunk from the right coronary sinus.

The association between prolongation in QRS duration and presence of coronary collateral circulation in patients with acute myocardial infarction

Background It is known that QRS duration is related to prognosis in acute myocardial infarction. The relation between QRS duration and coronary collateral circulation is uncertain. In the present study, we aimed to determine the relation between QRS duration and coronary collateral circulation in patients admitted with acute myocardial infarction. Methods The present study was composed of 109 consecutive patients with acute myocardial infarction. All patients had total occlusion in the left anterior descending coronary artery. Electrocardiographic recordings on admission were obtained for the assessment of QRS duration. The Rentrop classification was used to define coronary collateral circulation on coronary angiography. Patients were divided into two groups as follows: Group 1 with poor coronary collateral circulation (Rentrop 0–1) and Group 2 with good coronary collateral circulation (Rentrop 2–3). Results Of all patients, 62 patients were included in group 1 and 47 patients in group 2, respectively. In the present study, patients in the group 1 had longer QRS duration than patients in the group 2 (p < 0.005). Additionally, we found that Rentrop grading had negative correlation with both QRS duration and white blood cell count (r: −0.28; p < 0.005 and r: −0.35; p < 0.001). Conclusion Our study showed that there was an inverse relationship between QRS duration on admission and presence of coronary collateral circulation in patients with acute myocardial infarction.

OP-036 Effect of Hematologic Parameters on Reperfusion in ST Elevation Myocardial Infarction

WBC count, ( 109/L) 14,2 3,6 11,5 4 0,000 14,4 4 12,1 3,6 0,000 Neutrophil count ( 109/L) 11,6 3,6 8,8 3,3 0,000 11,8 3,7 9,5 3,4 0,000 Lymphocyte count, ( 109/L) 2,3 1,1 1,9 1,09 :0,004 2,43 1,9 1,96 1,05 :0,002 Platelet count ( 109/L) 268,4 68 253,7 74 :0,147 265,9 65 260 75 :0,603 Hemoglobin(g/dL) 13,9 1,3 13,4 1,2 :0,01 14 1,2 13,5 1,4 0,02 Mean platelet volume (fL) 9,8 1,6 9,1 1,3 :0,004 9,86 1,3 9,33 1,6 :0,012 N/ L ratio 7,2 6,8 6,9 5,6 :0,690 6,9 4,6 7,3 7 0,733 P/N ratio 25,4 10,6 32,4 16 :0,000 24,1 8,6 31,2 16 0,000