Necdet Akkus

Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS.

Objective. — Slow coronary flow (SCF) is a phenomenon characterized by delayed opacification of coronary arteries in the absence of epicardial occlusive disease, in which many aetiological factors such as microvascular and endothelial dysfunction, and small vessel disease have been implicated. We aimed to investigate the epicardial resistance in relation with SCF by using fractional flow reserve (FFR) and intravascular ultrasound (IVUS). Both have been combined to disclose the related epicardial flow resistance and the arterial anatomy. Methods and results. — Coronary pressure and FFR measurement were performed in 19 (8 (42.1%) men, 11 (57.9%) women; age = 55.9 ± 9.4 years) patients with SCF. All patients underwent subsequent IVUS investigation at the same setting. As compared with expected normal values, FFR values were significantly lower (1.0 vs. 0.83 ± 0.13, p < 0.0001). In patients with SCF, a strong negative correlation was seen between TIMI frame count and FFR (r = –0.551, p < 0.05). Upon IVUS investigation, the common finding was longitudinally extended massive calcification throughout the epicardial arteries and increased intimal thickness (0.59 ± 0.18mm). A negative correlation between intimal thickness and FFR was determined (r = –467, p < 0.05). Conclusion. — We have demonstrated the decreased FFR in the patients with SCF. Decreased FFR levels have been attributed to increased resistance in the epicardial coronary arteries due to diffuse atherosclerotic disease which has been demonstrated by IVUS.

Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy.

OBJECTIVE Our aim was to determine if there was any detectable clinical and cardiac changes in hypertrophied adenotonsillary disease with obstructive sleep apnea syndrome and to demonstrate the curative effect of adenotonsillectomy on these patients. METHODS Thirty-three children with adenotonsillary hypertrophy and sleep related breathing disorders were included in this study group. There were 16 female and 17 male patients and the mean age was 6.9+/-2 years. Age and sex matched control group consisted of 33 children (16 female, 17 male) with a mean age of 6.3+/-2. Complete clinical and laboratory examinations were done for each patient. The results were analysed with the SPSS (statistical package for social sciences) computer program. The significance of changes was performed by means of the independent samples of one-tailed t-test. For categorical variables, chi-square analysis was performed. RESULTS According to our snoring scale, snoring was mild in six patients (18.2%), moderate in 19 patients (57.5%) and severe in eight patients (24.3%). Severe apnea was not observed in any patients, moderate apnea in ten patients (30.3%) and mild apnea was observed in 23 patients (69.7%) preoperatively. Nine patients had Grade IV tonsils, 14 patients Grade III, seven patients Grade II, three patients Grade I. Twelve patients had 3+ (obstructive) adenoids, 21 patients had 2+ adenoids. Chest X-rays showed cardiomegaly in two patients with moderate degree of apnea. Electrocardiogram results were abnormal in four patients. When we compared echocardiographic results of study and control groups, we found several significant differences (RV: 1.6+/-0.3 vs 1.4+/-0.2; P<0.05, LVEDD: 3.6+/-0.5 cm vs 3.3+/-0.4; P<0.05, IVS: 6.8+/-1.4 mm vs 6.1+/-1.1 mm; P<0.05). Also a decreased left ventricular compliance measured by prolongation of deceleration time was found in patient group (DT: 173+/-44 vs. 126+/-22 ms; P<0.001). The echocardiographic results in postoperative group were similar to control group. CONCLUSION This study illustrated that adenotonsillary disease with obstructive sleep apnea symptoms leaded to right and/or left ventricular enlargement, hypertrophy when compared with control subjects, which were recovered postoperatively.

Predictive Value of P‐Wave Signal‐Averaged Electrocardiogram for Atrial Fibrillation in Acute Myocardial Infarction

Background: Atrial fibrillation (AF) is a common complication of acute myocardial infarction (AMI) with a reported incidence of 7–18%. Recently, P‐wave signal‐averaged electrocardiogram (P‐SAECG) has been used to assess the risk of paroxysmal AF attacks in some diseases. The aim of this study was to determine prospectively whether patients with AMI at risk for paroxysmal AF would be identified by P‐SAECG and other clinical variables.

The relationship between paraoxonase-1 activity and coronary artery disease in patients with metabolic syndrome.

OBJECTIVES We investigated the correlation of serum paraoxonase-1 (PON-1) activity with coronary artery disease (CAD) in patients with metabolic syndrome (MetS). STUDY DESIGN The study included 21 patients (mean age 55 ± 9 years) with MetS, stable angina pectoris, and angiographically shown CAD, 24 patients (mean age 51 ± 10 years) with MetS and angiographically normal coroner arteries, and 28 healthy controls (mean age 49 ± 12 years). Demographic and clinical characteristics, insulin levels, homeostasis model assessment of insulin resistance index, and PON-1 activity were assessed in all the groups. Severity of CAD was assessed using the Gensini score. RESULTS Paraoxonase-1 activity was significantly lower in patients with MetS compared to the control group (p=0.02). The two MetS groups with and without CAD exhibited similar characteristics in all the parameters including PON-1 activity (p>0.05). Univariate correlation analysis performed in MetS-CAD patients showed a significant negative correlation between the Gensini score and PON-1 activity (r=-0.48, p=0.02). The overall PON-1 activity of all the subjects showed no correlation with the parameters examined. CONCLUSION Decreased PON-1 activity in patients with MetS compared to the control group suggests increased oxidative stress in MetS. Detection of similar PON-1 activity levels in MetS groups with and without CAD suggests that disturbance of oxidative-antioxidative balance occurs before the development of CAD. The negative correlation between the Gensini score and PON-1 activity implies that decreased PON-1 activity may be one of the etiologic causes of atherosclerotic progress in MetS.

Effects of atrial pacing on coronary sinus endothelin-1 and nitric oxide levels in patients with myocardial bridging

Myocardial bridging (MB) is associated with clinical and metabolic evidence of ischaemia. In the present study, we aimed to evaluate the extent of atherosclerosis and endothelial dysfunction in patients with MB. The study population consisted of 15 patients with MB [9 women (60%), aged 56 ± 9 years] and 14 control subjects [8 women (57%), aged 54 ± 10 years]. All patients underwent coronary angiography. The femoral artery and coronary sinus endothelin-1 (ET-1) and nitric oxide (NOx) plasma levels were measured before and after right atrial pacing in all subjects. Also, intravascular ultrasonography was performed in 13 patients with MB. With right atrial pacing, coronary sinus ET-1 levels increased significantly in patients with MB compared with baseline levels (5.77 ± 6.76 versus 11.32 ± 9.40 pg/ml, p < 0.05). The coronary sinus ET-1 levels remained unchanged in controls with pacing (3.99 ± 4.00 versus 4.19 ± 7.15 pg/ml, p > 0.05). There was no significant difference between the two groups according to the increase in NOx levels with atrial pacing.Ten (77%) of the 13 patients had plaque formation in the segments proximal to the bridge with an area stenosis of 37 ± 21% (12% to 75%). In patients with MB, post-pacing levels of coronary sinus ET-1 correlated significantly with the cross-sectional area of the plaque (r = 0.65, p = 0,04). Increased ET-1 levels and the pathological data of intravascular ultrasonography may be associated with endothelial dysfunction and atherosclerosis development in patients with MB.The presence of atherosclerosis in the proximal segments to the bridge may contribute to the myocardial ischaemia detected in these patients.