Mustafa Zungur

Bilateral Diagonal Earlobe Crease and Coronary Artery Disease: A Significant Association

Background: The association between the presence of diagonal earlobe crease (ELC) and coronary artery disease (CAD) still remains controversial. Objective: The aim of this study was to evaluate the association between bilateral ELC and CAD. Methods: 415 patients were examined for the presence or absence of bilateral ELC, angiographic evidence of CAD and coronary risk factors. The patients were divided into 2 groups according to angiographic evidence of CAD. Results: Bilateral ELC was significantly and positively correlated with CAD, hypertension, age, male gender, cigarette smoking and family history of CAD. The ELC was an independent variable for CAD. The observed sensitivity, specificity, positive predictive value and negative predictive value of the bilateral ELC for the diagnosis of CAD were in the following order: 51.3, 84.8, 89.4 and 41.2%. Conclusion: The presence of bilateral ELC was significantly associated with CAD and coronary risk factors. The bilateral ELC was an important dermatological indicator of CAD, and it might be a useful diagnostic tool in the clinical examination of patients.

Impaired systolic blood pressure recovery and heart rate recovery after graded exercise in patients with metabolic syndrome.

Abstract The aim of this study was to evaluate and compare systolic blood pressure recovery and heart rate recovery (HRR) values obtained at various time intervals after maximal graded exercise treadmill testing between patients with metabolic syndrome (MS) and the controls without MS. To our knowledge, this is the first study indicating systolic blood pressure recovery (SBPR) impairment and its relations to HRR and other variables in this group of patients. The study population included 110 patients with MS (67 men, 43 women; mean age: 46 ± 9 years) and 110 control subjects who did not meet the criteria for MS (58 men, 52 women; mean age: 44 ± 10 years). All patients were selected from nonobese, apparently healthy sedentary individuals who had the ability to perform maximum exercise testing. SBPR was assessed by calculating the ratio of systolic blood pressure (SBP) obtained in the third minute of the recovery period to either the peak-exercise SBP or the SBP in the first minute of the recovery period after graded exercise testing. HRR values were calculated by subtracting the HR at the first, second, third, fourth, and fifth minutes of the recovery period from the HR reached at peak exercise. There was no significant difference found between the 2 groups with respect to age and sex distribution. As expected, patients with MS had higher waist circumference, fasting plasma glucose and serum triglyceride, and lower high-density lipoprotein cholesterol compared with control subjects. All HRR values calculated in the first, second, third, fourth, and fifth minutes were significantly detected lower in the MS group compared with the control group (HRR 1st: 32 ± 10 vs 36 ± 11; P = 0.009; HRR 2nd: 47 ± 10 vs 51 ± 11; P = 0.02; HRR 3rd: 53 ± 11 vs 58 ± 12; P = 0.001; HRR 4th: 57 ± 11 vs 64 ± 12; P < 0.001; HRR 5th: 60 ± 16 vs 69 ± 15; P < 0.001). In addition, calculated mean values for SBPR1 and SBPR2 were >1 in patients with MS (1.01 ± 0.2 vs 0.91 ± 0.1 and 1.01 ± 0.1 vs 0.94 ± 0.1) and these were statistically significant compared with the control group (P < 0.001 and P = 0.002, respectively). The existence of MS was found to be the only parameter that was independently and positively related to SBPR values in the study population. Our findings suggest that only the existence of MS itself, not the presence of any MS components, is independently associated with SBPRs. We are of the opinion that significantly impaired SBPR values, in addition to the decreased HRR values observed in this group of patients, such as those with MS, may especially help identify patients with potentially increased cardiovascular risk despite normal exercise stress testing findings.

Myocardial infarction in a 17-year-old patient due to neurofibromatosis-associated coronary aneurysm.

Neurofibromatosis is an autosomal dominant multi-system genetic disorder. Extra-cardiac vascular manifestations of neurofibromatosis have been previously described in many reports. However, coronary arterial involvements have been rarely described. A 17-year-old girl with neurofibromatosis presented to our institute with subacute myocardial infarction. Coronary angiogram revealed an aneurysm with thrombus in the left anterior descending artery.

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients.

Background GRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI). Objective The present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS. Methods We evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS). Results Systolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438). Conclusion End-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS.

Coronary artery perforations: Four different cases and a review

Coronary artery perforation (CAP) is a rare but feared complication of percutaneous coronary intervention. With the advent of new devices and technologies, interventionalists attempt more complex lesions, including more calcified or tortuous vessels and chronic total occlusions, which increases the incidence of CAP. A short literature review, in addition to four cases of CAP, is presented in this report.

Manual Thrombus Aspiration and the Improved Survival of Patients With Unstable Angina Pectoris Treated With Percutaneous Coronary Intervention (30 Months Follow-Up)

AbstractThe clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris.We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015.Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.80 ± 1.11 vs 4.23 ± 0.89, P = 0.012; troponin T: 0.012 ± 0.014 vs 0.018 ± 0.008, P = 0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean follow-up period of 28.87 ± 6.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16–18.21, P = 0.029).Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better survival over a 30-month follow-up period.

The Importance of Contrast Volume/Glomerular Filtration Rate Ratio in Contrast-Induced Nephropathy Patients after Transcatheter Aortic Valve Implantation

Background/Aim: Transcatheter aortic valve implantation (TAVI) is a method which is increasingly applied in severe aortic stenosis treatment. The development of contrast-induced nephropathy (CIN) after TAVI increases morbidity and mortality rates. Within the scope of this study, the importance of the contrast medium volume to glomerular filtration rate (CV/GFR) ratio in determining the development of CIN and the amount of CV that could be applied was evaluated. Methods: Seventy-two patients (aged 78.6 ± 11.6 years; 38 females) who underwent aortic valve replacement with the TAVI method between June 2013 and August 2014 were included in the study. CIN was defined as an absolute increase in serum creatinine of >0.5 mg/dl or a relative increase of >25% within 48-72 h after TAVI. CIN+ and CIN- patients were classified into two groups. The χ2 test, t test, Mann-Whitney U test, ROC analysis, and univariate and multivariate regression analyses were applied for statistical analyses. Results: CIN was detected in 16 patients (22%) in our study. Baseline creatinine, baseline GFR, the Mehran risk score, CV, and the CV/GFR ratio were determined as the predictive factors of CIN development. A CV/GFR ratio of 3.9 was specified to predict CIN development with 71% sensitivity and 80% specificity. Conclusion: After TAVI, CIN may develop due to various reasons. In patients to whom TAVI was applied, the CV/GFR ratio may be a guideline helping to prevent the development of renal pathologies. The amount of contrast medium that can be given to a patient can be calculated in terms of baseline GFR.

Importance of EuroSCORE-II in the Development of Acute Ischemic Heart Failure After Acute Anterior ST Elevation Myocardial Infarction

Introduction: We aimed to evaluate the importance of the EuroSCORE-II (ES-II) risk-scoring system in predicting the development of acute ischemic heart failure (AIHF) after acute anterior ST segment elevation myocardial infarction (A-STEMI). Patients and Methods: A total of 261 patients (206 male; mean age, 63.5 ± 14.2 years) admitted to our centre with A-STEMI between April 2012 and January 2013 were included in the study. The patients were divided into two groups according to their clinical fi ndings and were prospectively followed during the hospitalisation period for the development of cardiac morbidity and mortality. These groups were the AIHF group (n= 69) and non-AIHF group (n= 192). For the diagnosis of AIHF, we considered the recommendations of the European Society of Cardiology Guidelines on Heart Failure and the Framingham criteria. Results: According to our results, the morbidity and mortality rates were higher in the AIHF group. Symptom-to-balloon time, ejection fraction (EF), glomerular fi ltration rate (gfr), no-refl ow phenomenon, left main coronary artery disease and ES-II, which are the predictors of the development of AIHF, were determined via logistic regression analysis. ROC analysis revealed that symptom-to-balloon time > 209.5 min, EF < 36.5%, gfr < 68.5 mg/dL/1.73 m and ES-II > 4.9% were the cut-off values in the development of AIHF. Conclusion: Patients with A-STEMI complicated by AIHF have signifi cantly high mortality rates. With the pre-estimation of the development of AIHF, complication rates can be reduced. For this purpose, ES-II score > 4.9% can be used as a predictor of AIHF after A-STEMI.

Importance of Femoral Access Method in Predicting the Development of Contrast Induced Nephropathy after Transfemoral Transcatheter Aortic Valve Implantation

Introduction: Transcatheter aortic valve implantation (TAVI) is more reliable than surgical valve replacement for high-risk or inoperable aortic stenosis patients. In this study, we aimed to investigate the effects of different femoral access methods on the development of vascular complications and contrast-induced nephropathy (CIN) after transfemoral (TF)-TAVI. Patients and Methods: In total, 110 patients (aged 78.9 ± 12.2 years; 55 females) who underwent aortic valve replacement by TF-TAVI between June 2013 and April 2015 were included in the study. CIN was defi ned as an absolute increase in serum creatinine level of > 0.5 mg/dL or a relative increase of > 25% within 48-72 h after TF-TAVI. The patients were classifi ed into two groups according to the femoral access methods: surgical cut-down (SCD) and vascular closure device (VCD) groups. Results: The amount of contrast medium (CM; p< 0.001) and the incidence of CIN (p= 0.038) were higher in the VCD group. Baseline glomerular fi ltration rate (GFR), baseline creatinine, Mehran score and CM were determined as the predictive factors of CIN development. Receiver operating characteristic analysis revealed that CM, which may predict the development of CIN, was determined as 178.5 mL, and GFR, which may predict the development of CIN, was determined as 48.9 mL/dk/1.73 m. Conclusion: It may be preferred to perform the femoral arterial procedure using the SCD method instead of VCD in TAVI patients whose GFR is < 48.9; the use of CM may increase due to various reasons.

The change in right ventricular systolic function according to the revascularisation method used, following acute ST -segment elevation myocardial infarction.

OBJECTIVE The level of right ventricular (RV) systolic function has prognostic importance in right ventricular ST-segment elevation myocardial infarction (RV-STEMI). This study aimed to evaluate the changes in RV systolic function in patients with RV-STEMI according to the revascularisation method used for their management. METHODS The first group consisted of 132 patients who received primary percutaneous coronary intervention (PPCI). The 78 patients who had received thrombolytic therapy (TT) in external centres before referral to our centre for PCI within three to 12 hours of RV-STEMI were included in the second group. All patients were evaluated by conventional and two-dimensional speckle-tracking echocardiography. RESULTS There were 172 male patients and their mean age was 63.7 ± 11.8 years. There were no significant differences between the two groups with regard to right ventricular systolic parameters at admission and at the one-month follow-up visit. The echocardiographic changes between admission and the one-month follow up were investigated for the patients included in the study groups. Mean values of each parameter observed at the one-month follow up were significantly increased compared to those at admission within each group. CONCLUSION Our study demonstrated that PCI within three to 12 hours following TT provided similar benefits on right ventricular systolic function compared to PPCI in patients with RV-STEMI.