Nihat Pekel

The relationship between platelet indices and clinical features of coronary artery disease

BACKGROUND Platelets play a key role in the development and progression of cardiovascular disease. The degree of platelet activation may be assessed by platelet indices such as platelet count, mean platelet volume (MPV) and platelet distribution width (PDW). AIM To evaluate the relationship between platelet indices and clinical features of coronary artery disease (CAD). METHODS Our population is represented by a total of 441 consecutive patients undergoing coronary angiography. Patients were divided into three groups according to their clinical presentation: Patients with stable angina (Group I), with acute coronary syndrome (Group II), and with a normal coronary angiogram (Group III). All demographic and clinical features were collected retrospectively. Platelet indices were measured in all patients. RESULTS There was no statistical difference for platelet count, MPV and PDW values among the groups. Correlation analysis showed a positive association between platelet count and Gensini scoring (Kendalls tau b, r = 0.312, p = 0.037, two-tailed)and also age (Kendalls tau b, r = 0.518, p = 0.001, two-tailed) in patients with CAD. However, there was no significant correlation between Gensini scoring and MPV or PDW values in these patients. CONCLUSIONS PDW and MPV may not be related to the clinical features or presentation and extent of CAD. Our study findings add to the conflicting results of previous studies in this area. Prospective trials with longer follow-up periods and larger samples are warranted to conclusively define the role of platelet indices in CAD.

Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: Perspectives from the observational, prospective WATER Registry

BACKGROUND Warfarin is highly efficacious in reducing stroke risk in patients with atrial fibrillation (AF). However, its safety and efficacy in stroke prevention is markedly influenced by its time in therapeutic range (TTR). The quality of anticoagulant therapy varies considerably among countries. Representative data concerning the quality of anticoagulant therapy and its effects on clinical outcomes in Turkey are lacking. METHODS Warfarin in Therapeutic Range (WATER) registry is a prospective, observational study which followed 572 AF patients (mean age 67.3 ± 12 years; females 60%; 71% non-valvular AF) treated with warfarin. RESULTS At a median of 22-month follow-up, the mean TTR value was 42.3 ± 18% (median: 40%) for the whole population and lower in non-valvular AF su group than valvular AF subgroup (40.3 ± 18 vs. 46.9 ± 19, respectively, p < 0.001). Death, cardiac hospital-ization and minor bleeding rates were higher in the group with TTR value < 40% than the group with > 40% (3.4% vs. 5.9%; 28.6% vs. 35.4%; 36.5% vs. 41.7%, respectively, all of them p < 0.001). A correlation analysis showed a negative correlation between age and TTR value (r = -0.178, p < 0.001). Mean CHA2DS2VASc score was 3.63 ± 1.5 and mean HASBLED score was 2.38 ± 1.01 in the non-valvular AF group. A negative correlation was observed between TTR levels and CHA2DS2VASc score. CONCLUSIONS WATER provides insight into the anticoagulation control status of AF patients in Turkey. The quality of anticoagulation was poor. Strategies should be undertaken by clinicians and patients to improve TTR. New oral anticoagulant agents may be perfect alternatives for non-valvular AF patients.

Optimal treatment of unligated side branch of internal mammary artery: Coil, amplatzer vascular plug or graft stent? A case report and literature review.

Coronary artery steal syndromes may occur following coronary artery bypass grafting as a result of the presence of large side-branches arising from the internal mammary artery (IMA). Coil embolization, Amplatzer Vascular Plug and graft stents are all used for the treatment of such syndromes. The literature contains limited data on the long-term success of these treatment methods. There is no large series regarding occluded IMA side branches causing coronary steal phenomena, and data on long-term follow-up of this treatment method is also very limited. This report presented two cases and their treatment, and reviewed the advantages and disadvantages of treatment methods and the factors that affect successful treatment.

Directly ventricular septal defect closure without using arteriovenous wire loop: Our adult case series using transarterial retrograde approach

Objective: The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure. Methods: Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18–58), the mean height was 168.75 cm (Range 155–185cm), and the mean body mass index was 23.4 (Range 17.3–28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side. Results: The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach using AV loop. We didn’t encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively. Conclusion: Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and shortens the procedure time. The only limitation in adult patients is delivery sheath length.

Design and rationale of dabigatran's stroke prevention in real life in Turkey (D-SPIRIT).

OBJECTIVE The D-SPIRIT registry is designed to investigate the safety and efficacy of dabigatran etexilate in patients with nonvalvular atrial fibrillation (NVAF) and to collect data on outcomes in clinical practice. METHODS The D-SPIRIT is a national, prospective, observational, post-marketing registry involving patients with NVAF who have been taking dabigatran etexilate therapy for stroke prevention for a minimum of 6 months prior to enrollment. The registry will collect and analyze data from routine care, enrolling up to 600 patients in 9 centers. Patients will be followed up for 2 years to evaluate effectiveness and safety. A sample size of 600 subjects is proposed based on the following assumptions; Two-sided significance level of 0.05 (1-sided significance level of 0.025), ischemic stroke incidence rate of 0.768%-1.111%, hemorrhagic stroke incidence rate of 0.109%-0.130%, transient ischemic attack incidence rate of 0.722%-0.623%, therapy discontinuation incidence rate of 40% at day 730, and duration of enrollment period of 12 months with non-uniformed enrollment rate. Ethics approval was given by Dokuz Eylül University Ethics Committee of Clinical Research (2014/54) and approved by the Turkish Ministry of Health. CONCLUSION Potential results of D-SPIRIT registry will add data from clinical practice to those from the RE-LY trial to expand knowledge of dabigatran etexilate treatment in patients with NVAF.

Spontaneous spinal epidural hematoma developing after percutaneous coronary intervention: early diagnosis, early intervention, and good outcome.

A 56-year-old female patient hospitalized with diagnosis of acute coronary syndrome underwent early coronary intervention. Anticoagulant and antithrombotic treatment was administered, including acetylsalicylic acid, clopidogrel, and heparin in periprocedural period. Severe back pain and rapidly progressing paraplegia developed in early period of follow-up. The patient underwent surgery immediately after diagnosis of spontaneous spinal epidural hematoma (SSEH) causing pressure, and decompression was performed. The patient rapidly improved without recurrence through early diagnosis and early surgical intervention. A common problem encountered by interventional cardiologists is back pain in patients who have undergone interventions in the femoral region and have lain in the same position for an extended period. Clinical onset of SSEH includes similar complaints, a fact of which cardiologists should be aware. Early diagnosis and early intervention may provide a good outcome, as is reported in the present case.

PP-129 An Unusual Pacemaker Syndrome Case: Recurrent Pericardial Tamponade

A B S T R A C T S junctional bradycardia and regained consciousness. Short-term of second degree atrioventricular block was observed before normal sinus rhythm. Dual-chamber pacemaker with rate drop response was implanted to the patient. His further clinical course was uneventful. Conclusions: Prolonged asystole during HUT has been proposed to identify a distinct subgroup of patients with neurocardiogenic syncope. Management including permanent pacemaker implantation might be performed for prevention of syncope. Physicians should be aware of potential complications such as prolonged asystole during HUT.

Kapiller kandan INR monitorizasyonunun güvenilirliği

Aim: Vitamin K antagonists (VKA) are the main drugs used in primary and secondary prevention of cardiovascular embolic diseases. In long term therapy with VKA, the efficacy and safety of therapy primarily depends on the INR level. The necessity of INR monitorization is the major difficulty in routine usage of these drugs. INR selftest devices are created to overcome this difficulty by analyzing INR from capillary blood in outof-hospital settings. Although these devices are present in medical markets for the last 20 years, the number of patients using these devices are only about %1 of the whole number of patients on VKA therapy. The major factor limiting the widespread usage of these devices is the limited clinical experience of the clinicians which lead to the distrust about accuracy of this testing. In this study we aimed to investigate the accuracy of INR selftest devices. Method: 55 patients on long term VKA therapy for any reason were enrolled to the study. The patients were selected from those, who were admitted to Dokuz Eylul University Cardiology polyclinics for INR monitoization. The INR levels of the patients were analyzed both by classical method (BCSXP; Siemens) and INR selftest device (Coagucheck; Roche) within the same day. Measured INR levels by two methods were assessed by Spearman correlation and Bland-Altman analysis. Results: Spearman correlation analysis of the INR values of INR selftest device and classical INR testing showed a strong correlation (r=0.960 ve p<0.0001). Bland-Altman analysis demonstrated that, except for 2 values, all of the INR values were within %95 confidence interval. The mean of the differences between two tests was 0.05. Mean value of INR selftest device INR levels were only 0.05 higher than the mean value of classical method levels. Conclusions: The results of the study showed that, INR selftesting via capillary blood is accurate and safe. Sharing the results of similar studies will lead a more widespread usage of these devices

[Stable coronary artery disease management: what has changed in the 2013 European Society of Cardiology guideline?].

Avrupa Kardiyoloji Dernegi en son 2006 yilinda yayimlamis oldugu kararli anjina pektoris tedavi kilavuzunu yeni calismalar isiginda 2013 yilinda guncellemistir.[1] Yeni kilavuz, 2006 yilinda yayimlanan kilavuz ile karsilastirildiginda kararli koroner arter hastaligi (KAH) taniminin yeniden gozden gecirildigi, tanisal degerlendirme ve tedavi yonlendirmelerinde bir takim degisiklikler yapildigi gorulmektedir.