Musa Cakici

Increased Platelet Distribution Width Is Associated With ST-Segment Elevation Myocardial Infarction and Thrombolysis Failure

We investigated 2 hypotheses: (1) a relationship between platelet indices and stable coronary artery disease (CAD) and acute ST-segment elevation myocardial infarction (STEMI) and (2) a relationship between platelet indices on admission and thrombolysis outcomes in patients with STEMI. A total of 260 patients were enrolled. The white blood cell (WBC) and platelet distribution width (PDW) were found to be increased in patients with STEMI (P for both < .001). White blood cell and PDW were independent predictors of acute STEMI. Mean platelet volume (MPV) and PDW were significantly higher in the thrombolysis failure group than in the thrombolysis success group (9.9 ± 1.8 vs 9.2 ± 1.5 fL, P = .021 and 17.7 ± 1.0 vs 16.4 ± 2.1 fL, P < .001, respectively). Mean platelet volume and PDW were independent predictors of thrombolysis failure. Patients with acute STEMI had higher PDW than did patients with stable CAD. In addition, higher PDW and MPV seem to correlate with thrombolysis failure in patients with STEMI.

Prediction of Coronary Artery Disease Severity Using CHADS2 and CHA2DS2-VASc Scores and a Newly Defined CHA2DS2-VASc-HS Score

As the CHADS2 and CHA2DS2-VASc scores include similar risk factors for the development of coronary artery disease (CAD), they may provide crucial information regarding the severity of coronary artery lesions and the risk of thromboembolism. To increase the likelihood of determining CAD severity, we formulated the CHA2DS2-VASc-HS score comprising hyperlipidemia and smoking in addition to the components of the CHA2DS2-VASc score and male instead of female gender. We aimed to investigate whether these 3 risk scores can be used to predict CAD severity. A total of 407 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients, 87 had normal coronary angiograms and served as group 1. The remaining 320 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or ≥50%: 123 patients with mild CAD as group 2 and 197 patients with severe CAD as group 3. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were significantly different among the 3 groups. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores correlated significantly with the number of diseased vessels (r = 0.406, p <0.001; r = 0.308, p <0.001; and r = 0.533, p <0.001, respectively) and the Gensini score (r = 0.383, p <0.001; r = 0.300, p <0.001; and r = 0.500, p <0.001, respectively). The CHA2DS2-VASc-HS score was found to be the best scoring scheme to predict CAD severity in the area under the curve comparison of these scoring systems. For prediction of severe CAD, the cut-off value of CHA2DS2-VASc-HS score was >2 with a sensitivity of 85.2% and a specificity of 57.5% (area under the curve 0.802, 95% confidence interval 0.760 to 0.839, p <0.001). In conclusion, our findings suggest that the CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS scores could be considered predictive of the risk of severe CAD.

Relation of Epicardial Fat Thickness with Carotid Intima-Media Thickness in Patients with Type 2 Diabetes Mellitus

Aims. The aim of this study was to investigate the relationship of echocardiographic epicardial fat thickness (EFT) with carotid intima-media thickness (CIMT), in patients with type 2 diabetes mellitus (T2DM). Methods and Results. A total of 139 patients with T2DM (mean age 54.3 ± 9.2 and 49.6% male) and 40 age and sex-matched control subjects were evaluated. Echocardiographic EFT and ultrasonographic CIMT were measured in all subjects. Patients with T2DM had significantly increased EFT and CIMT than those of the controls (6.0 ± 1.5u2009mm versus 4.42 ± 1.0u2009mm, P < 0.001 and 0.76 ± 0.17u2009mm versus 0.57 ± 0.14u2009mm, P < 0.001, resp.). EFT was correlated with CIMT, waist circumference, BMI, age, duration of T2DM, HbA1c in the type 2 diabetic patients. Linear regression analysis showed that CIMT (β = 3.52, t = 3.72, P < 0.001) and waist circumference (β = 0.36, t = 2.26, P = 0.03) were found to be independent predictors of EFT. A cutoff high risk EFT value of 6.3u2009mm showed a sensitivity and specificity of 72.5% and 71.7%, respectively, for the prediction of subclinical atherosclerosis. Conclusion. We found that echocardiographic EFT was significantly higher in patients with T2DM. Our study also showed that EFT was strongly correlated with waist circumference and CIMT as being independent of sex.

Effect of smoking on Tp-e interval, Tp-e/QT and Tp-e/QTc ratios as indices of ventricular arrhythmogenesis.

BACKGROUNDnSmoking may lead to ventricular arrhythmias and sudden cardiac death via altering ventricular recovery time dispersion indices such as QT interval and QT dispersion (QTd). The Tp-e/QT and Tp-e/QTc ratios are also known as predictors of ventricular arrhythmogenesis. The aim of this study was to evaluate the relationship between cigarette smoking and ventricular repolarisation dispersion using these novel electrocardiographic parameters.nnnMETHODSnOne hundred and twenty-one chronic smokers and 70 age- and sex-matched non-smoker controls were included in our study. The Tp-e interval and Tp-e/QT ratio were measured by 12-lead electrocardiogram, and corrected for heart rate.nnnRESULTSnQTd (34.2 ± 8.4, 27.2 ± 10.4, P<0.001) and corrected QTd (37.3 ± 8.9, 29.8 ± 11.2, P<0.001) were significantly increased in the smokers compared to the non-smoker control group. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, P<0.001), cTp-e interval (83.5 ± 8.0, 77.1 ± 8.7, P<0.001), Tp-e/QT (0.20 ± 0.03, 0.19 ± 0.02, P<0.001) and Tp-e/QTc ratios (0.19 ± 0.02, 0.17 ± 0.02, P<0.001) were increased in the patient group when compared to the controls. Significant positive correlations were also found between the level of smoking with the cTp-e interval (r=0.836, P<0.001), and Tp-e/QT (r=0.714, P<0.001) and Tp-e/QTc ratios (r=0.448, P<0.001).nnnCONCLUSIONnWe found in our study that cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in smokers and significantly correlated to the amount of smoking.

Negative Effects of Acute Sleep Deprivation on Left Ventricular Functions and Cardiac Repolarization in Healthy Young Adults

Sleep deprivation (SD) is associated with an increased incidence of adverse cardiovascular events, we aimed to determine the impact of acute SD on structural and functional alterations of the left ventricle (LV) and on electrocardiogram (ECG) markers including T wave peak‐to‐end interval (TpTe), QT interval, and TpTe/QT ratio in healthy subjects after a night of SD.

Unusually located left ventricular outflow myxoma: a brief review of the literature.

Among all myxomas, left ventricular outflow tract (LVOT) myxomas are very rare. This article reports an LVOT myxoma in a 67-year-old woman presenting with palpitations and weight loss. Surgical excision of the LVOT myxoma was performed.

Relationship between severity of pulmonary hypertension and coronary sinus diameter

INTRODUCTION AND OBJECTIVEnWe investigated the relationship between coronary sinus (CS) diameter and pulmonary artery systolic pressure (PASP) in patients with pulmonary hypertension (PH) and normal left ventricular systolic function.nnnMETHODSnA total of 155 participants referred for transthoracic echocardiography were included in the study. The study population consisted of 100 patients with chronic PH and 55 control subjects. Patients with PH were divided into two groups according to PASP: those with PASP 36-45 mmHg, the mild PH group (n=53); and those with PASP >45 mmHg, the moderate to severe PH group (n=47). CS diameter was measured from the posterior atrioventricular groove in apical 4-chamber view during ventricular systole according to the formula: mean CS=(proximal CS+mid CS+distal CS)/3.nnnRESULTSnMean CS diameter was significantly higher in the moderate to severe PH group than in the controls and in the mild PH group (1.12±0.2 cm vs. 0.82±0.1 cm and 0.87±0.1 cm, respectively; p<0.001). It was significantly correlated with right atrial (RA) area (r=0.674, p<0.001), RA pressure (r=0.458, p<0.001), PASP (r=0.562, p<0.001), inferior vena cava diameter (r=0.416, p<0.001), right ventricular E/A ratio (r=-0.290, p<0.001), and E/Em ratio (r=0.235, p=0.004). RA area (β=0.475, p<0.001) and PASP (β=0.360, p=0.002) were found to be independent predictors of CS diameter.nnnCONCLUSIONSnA dilated CS was associated with moderate to severe pulmonary hypertension, and RA area and PASP were independent predictors of CS diameter.

Isolated multiple invasive cardiac hydatid cyst

An 80-year-old man with a medical history of hypertension was referred to our clinic with a 2-month history of increasing dyspnoea. Physical examination was unremarkable. Echocardiography revealed multiple cystic mass localised to both intramyocardial and pericardial space (figure 1). A contrast-CT of the thorax revealed multiple cardiac cysts located on myocardium and pericardium (figure 2). Screening for other organ involvement including liver, lung and brain was negative. More than 10 cysts …

Mediastinal hydatid cyst compressing the pulmonary artery and atrial septal defect: A rare association

∗ Corresponding author. E-mail address: k.sedat@mynet.com (S. Koroglu). tionally, in short-axis view a mass was visualized invading the pulmonary artery, and continuous wave Doppler of the pulmonary artery revealed a maximum gradient of 40 mmHg. A detailed examination with cardiac magnetic resonance imaging demonstrated a multicystic mass in the mediastinum compressing the main pulmonary artery, predominantly the left branch (Figure 3). The patient was

Giant left atrial appandage thrombus due to atrial fibrillation: successful treatment with warfarin.

I read with interest the case presented by Ercan et al. recently published in your journal [1]. They presented a case of huge left atrial appendage (LAA) thrombus in a patient with atrial fibrillation (AF) that was successfully treated with the combination of acetylsalicylic acid, unfractionated heparin and tirofiban. We also initiated the same treatment (combination of acetylsalicylic acid, unfractionated heparin and tirofiban for eight day) to a similar patient with huge left atrial appendage thrombus due to atrial fibrillation. However, our treatment failed and thrombus persisted in this period. Our patient had high-risk for surgical treatment because of heart failure. Thus, we started warfarin to prevent thromboembolic complications. Thrombus completely disappeared in 6-weeks follow-up. A 62-year-old male with a history of heart failure admitted to our hospital with intermittent palpitation for last two weeks. On physical examination, he had irregular pulse and electrocardiogram showed atrial fibrillation with 85 beats per minute. Echocardiography showed global hypokinesia of left ventricular walls and ejection fraction was estimated to be 30% by modified Simpson’s method. We performed transeosophagial echocardiography (TEE) to exclude any thrombus formation in LA/LAA, because we planned to restore sinus rhythm. TEE revealed a giant mobile thrombus filling LAA and protruding to left atrium (Figure 1A). We started acetylsalicylic acid 100 mg daily, unfractionated heparin infusion by adjusting activated clotting time to 200–250 s and tirofiban infusion 11 cc/h adjusted according to his weight. Control TEE was performed 5 days after starting treatment and we saw no change in thrombus size and shape (Figure 1B). We continued the treatment, but still there was no change on the trombus formation confirmed by TEE on 10th day of the treatment (Figure 1C). Thus, the treatment was stopped. Warfarin was initiated and the patient was discharged with warfarin after adjusting international normalized ratio value between 2.0 and 3.0. TEE showed complete lysis of the thrombus in 6-weeks follow-up (Figure 2A–D). Incidence and prevalence of atrial AF are increasing significantly worldwied and this increase will probably impose a significant burdeb on healthcare resources. Two factors are mainly concerned in management of AF: symptom relief (through rate or rhythm control) and and prevention of complications. AF management including stroke prevention depends on multiple factors including patient age, comorbidities, and disease profile [2]. Left atrial appendage (LAA) has an anatomic structure very favorable for thrombus formation in patients with AF, who often experience limited contraction and stagnant blood flow. In fact, a review of published reports reveals that 90% of cardiothrombic events in patients with AF originate from the LA/LAA [2]. Many physicans want to restore sinus rhythm to improve symptoms and to protect from complications of AF. If AF duration is longer than 48 hours, TEE may be performed to rule out the presence of an intracardiac thrombus formation before cardioversion. If there is detectable thrombus in the LA/LAA, guidelines recommend warfarin for 3 weeks before and 4 weeks after cardioversion, but guidelines are not helpful when a giant thrombus is detected in LA/LAA [2, 3]. In a case which was published in your journal, Ercan et al. reported a huge left atrial appendage thrombus in a patient with atrial fibrillation which was successfully treated with the combination of acetylsalicylic acid, unfractionated heparin and tirofiban. We also administered same treatment to a similar patient over 10 days butthis method failed and we started warfarin. TEE showed complete lysis of the thrombus after warfarin treatment in 6 weeks follow-up. Development of a giant thrombus in LA/LAA due to AF is a very rare condition. Additionally, there is no consensus on how to treat a giant thrombus with AF in guidelines. Usually, heparin infusion is not enough, thrombolysis carries high risk of embolization and surgery seems as a risky treatment for LA/LAA thrombus. Glycoprotein2b/3a inhibitors may be considered as an alternative therapy for giant thrombus in LA/LAA. To our knowledge, glycoprotein2b/3a receptor blockers have been used in patients that have undergone percutaneous coronary intervention with a lower rate of bleeding and there are two reports on the successful use of glycoprotein2b/3a inhibitors in patients with mechanical prosthetic valve thrombosis[4, 5]. Additionally, Yuce et. al reported that tirofiban was successfully used for the treatment of atrial septal defect occluder device thrombus in a patient with heart failure [6]. However, there is no sufficient evidence for glycoprotein2b/3a inhibitors in these conditions. In our view, effective anticoagulation with warfarin Keywords