Nusret Acikgoz

Increased prevalence of varicocele in patients with coronary artery ectasia.

BackgroundCoronary artery ectasia (CAE) is defined as localized or diffuse non-obstructive lesions of the epicardial coronary arteries with a luminal dilation exceeding the 1.5-fold of normal adjacent segment or vessel diameter. Varicocele is the dilatation of the pampiniform plexus. Recently increased prevalence of peripheral varicose veins has been shown in patients with CAE. In this study we aimed to assess the prevalence of varicocele, which is dilatation of another venous system, in patients with CAE. Materials and methodsThirty-five male consecutive patients with coronary artery ectasia in combination with or without coronary artery disease (CAD) and 63 male, age-matched patients with coronary artery disease were included in the study. All patients were evaluated for the presence of varicocele. ResultsTwenty-one patients with CAE were found to have varicocele (62% of group I patients). In patients with CAD, 24 patients (38%) were found to have varicocele. The difference between the two groups in respect to presence of varicocele was statistically significant (P=0.02; odds ratio=1.57; 95% confidence interval 1.05– 2.3). ConclusionWe have shown that patients with coronary artery ectasia have an increased prevalence of varicocele compared to those with coronary artery disease. The mechanism underlying coronary artery ectasia might further increase the prevalence of varicocele in susceptible patients.

Impaired left ventricle filling in slow coronary flow phenomenon : An echo-doppler study

Slow coronary flow (SCF) in a normal-appearing coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. The aim of the study was to evaluate echocardiographic features in patients with SCF. Thirty-four patients with angiographically proven SCF (group I) and 25 patients with normal coronary flow (group II) were enrolled in the study. The diagnosis of SCF was made with use of the “TIMI frame count (TFC)” method. All patients underwent complete transthoracic echocardiographic examination (M-mode, 2-dimensional [2-D], and Doppler parameters such as color, continuous, pulsed wave). There were no significant differences with respect to systolic parameters between the 2 groups; in spite of these, group I showed impaired left ventricular diastolic patterns compared to group II. Group I patients had higher peak late diastolic filling velocities due to enhanced atrial systole (A), lower peak (E/A) diastolic filling velocity ratios, and longer isovolumetric relaxation times compared with group II, and these were statistically significant (p<0.001). In conclusion; the authors detected diastolic filling abnormalities and showed diastolic dysfunction in patients with SCF.

Subclinical left ventricular dysfunction in Behcet's disease assessed by two-dimensional speckle tracking echocardiography

AIMSnThe aim of this study was to evaluate the left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) in order to provide the early detection of myocardial dysfunction in patients with Behcets disease (BD). We also aimed to examine the relationship between LV systolic strain and N-terminal pro-B type natriuretic peptide (NT-proBNP), which is a cardiac biomarker of ventricular dysfunction.nnnMETHODS AND RESULTSnLongitudinal and circumferential systolic strain assessed by STE was obtained in 32 BD patients and 27 age-matched controls. NT-proBNP levels were also measured in all subjects. Regional and mean longitudinal strain (-17.8 ± 2.7 vs. -20.5 ± 1.8%; P < 0.0001) was significantly lower in BD patients when compared with the healthy controls. Whereas regional and mean circumferential strain values (-22.0 ± 1.6 vs. -22.2 ± 2.3%; P = 0.62) did not reveal a significant difference between the patients and the controls. NT-proBNP was significantly higher in the patients than in the controls (65.18 ± 84.51 vs. 30.84 ± 14.75 pg/mL; P = 0.003). Linear regression analyses revealed only NT-proBNP as the independent correlate of mean LV longitudinal strain (R = 0.603, P = 0.001).nnnCONCLUSIONnLongitudinal myocardial systolic function assessed by STE, which is a sensitive marker of subclinical ventricular dysfunction is impaired in BD. Increased NT-proBNP levels may be a sign of subclinical ventricular dysfunction in these patients.

Assessment of atrial electromechanical delay and influential factors in patients with obstructive sleep apnea

PurposeThe interaction between moderate-to-severe obstructive sleep apnea (OSA) and cardiac arrhythmias, especially atrial fibrillation (AF), is well known. We aimed to determine whether atrial electromechanical parameters assessed by tissue Doppler imaging (TDI) would be affected in moderate-to-severe OSA, and detect the influential factors of atrial electromechanical parameters in these patients.Methods and resultsInteratrial and intra-atrial electromechanical delay was measured by TDI in patients with moderate-to-severe OSA (nu2009=u200964) and control subjects (nu2009=u200939). P-wave dispersion (PWD) was calculated on the 12-lead ECG. Interatrial and intra-atrial electromechanical delay was significantly higher in the OSA group when compared with the controls (52.26u2009±u200912.9 vs 29.61u2009±u200911.26, Pu2009<u20090.0001 and 18.90u2009±u20098.13 vs 8.71u2009±u20095.46, Pu2009<u20090.0001; respectively). PWD was higher in the OSA group (46.09u2009±u200913.40xa0ms vs 34.10u2009±u200910.75xa0ms, Pu2009<u20090.0001). Interatrial electromechanical delay had a positive correlation with PWD (ru2009=u20090.490, Pu2009<u20090.0001), left atrial (LA) diameter (ru2009=u20090.383, Pu2009=u20090.002), LA volume index (ru2009=u20090.354, Pu2009=u20090.004), and apnea–hypopnea index (ru2009=u20090.365, Pu2009=u20090.003). In addition, interatrial electromechanical delay was negatively correlated with the magnitude of the lowest oxygen saturation percentage (ru2009=u2009−0.498, Pu2009<u20090.0001).ConclusionThis study showed that interatrial and intra-atrial electromechanical delay and PWD were prolonged in patients with moderate-to-severe OSA. LA dilatation, hypoxemia, and the severity of the disease may contribute a prolongation in interatrial electromechanical delay via atrial structural and electrical alterations, which may predict the risk of future AF development in patients with moderate-to-severe OSA.

Effect of ectasia size or the ectasia ratio on the thrombosis in myocardial infarction frame count in patients with isolated coronary artery ectasia

Coronary blood flow was quantified using the thrombosis in myocardial infarction (TIMI) frame-count method. This measurement has been significantly correlated with flow velocity measured invasively by use of a Doppler flow wire. Coronary artery ectasia or aneurysm (CEA) is thought to be present in patients with a slow blood flow. In this study, we aimed to assess the relationship between the ectasia size or ectasia ratio and TIMI frame count in patients with CEA. The study population included 58 patients with isolated CEA of the right coronary artery. In patients with CEA, an ectasia ratio was calculated as diameter of the ectatic segment/diameter of the adjacent normal segment. According to the ectasia ratio, ectatic vessels were divided into two groups: ectasias with a 1.5- to 2.0-fold increase (group A) and more than 2.0-fold increase (group B) in normal vessel diameter. Patients with a significant stenotic lesion (>50%) in the ectatic vessel were excluded. The control group was formed from a matched population of 35 patients with angiographically proven normal coronary arteries. Characteristics of the ectasia and control groups are similar. The TIMI frame counts for the right coronary artery (RCA) were significantly higher in the ectasia group as compared with the control group (43 ± 12 vs 23 ± 8, P < 0.001). The ectasia group had 38 patients in group A and 20 patients in group B. The TIMI frame counts were significantly higher in group B than in group A (43 ± 10 vs 51 ± 15, P < 0.05). The TIMI frame count of the RCA showed a significant correlation with the ectasia ratio and the maximum diameter of the ectatic segment (r = 0.578, P < 0.001 and r = 0.435, P < 0.001, respectively). Our data suggest that TIMI frame count measurement depends on the ectasia size or ectasia ratio, and an increased ectasia ratio is markedly associated with decreased TIMI frame counts in patients with CEA.

Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification.

The aim of our study was to investigate atrial conduction time in patients with mitral annulus calcification (MAC) using P-wave dispersion (PWD) and electromechanical coupling measured with the surface electrocardiogram and the tissue Doppler echocardiography. Fifty-nine patients with MAC and 43 control subjects underwent resting the surface electrocardiogram and tissue Doppler echocardiography. The difference between the maximum (Pmax) and minimum P-wave durations was calculated and defined as PWD. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler echocardiography. Both Pmax and PWD were higher in patients with MAC compared with controls (111.4 +/- 15.8 vs 97.3 +/- 18.8 milliseconds; P < .0001 and 46.4 +/- 14.6 vs 31.4 +/- 13.1 milliseconds; P < .0001, respectively). Both interatrial and intraatrial conduction time were also delayed in patients with MAC compared with controls (29.8 +/- 13.3 vs 17.6 +/- 12.5 milliseconds; P < .0001; 9.4 +/- 5.1 vs 6.8 +/- 4.0 milliseconds; P < .008, respectively). Left atrial (LA) diameter was significantly higher in patients with MAC compared with controls (35.4 +/- 5.0 mm vs 32.3 +/- 4.2 mm; P < .001). The LA diameter correlated significantly with both interatrial conduction times and PWD (r = 0.56; P < .0001 and r = 0.47; P < .0001, respectively). There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with MAC.

Comparison of direct stenting versus conventional stent implantation on blood flow in patients with ST-segment elevation myocardial infarction

As compared with balloon angioplasty, stent implantation in treatment of acute myocardial infarction (AMI) reduces abrupt vessel closure, restenosis, and reocclusion rate. However, a few studies have demonstrated the safety and feasibility of direct stenting compared to conventional stent implantation technique. This study was designed to compare possible advantages of direct stenting with conventional stent implantation on immediate coronary blood flow and short-term clinical benefits in patients with AMI. Fifty patients with AMI who underwent mechanical revascularization were eligible for the study. The patients were randomly assigned to undergo either direct stenting (n=25) or conventional stent implantation (n=25). Before and after the procedure thrombolysis in myocardial infarction (TIMI) flow and postprocedural corrected TIMI frame count (cTFC) of the infarct-related artery were measured. There was no difference in TIMI flow distribution at baseline between the 2 groups. TIMI 3 flow rate significantly increased after procedure in both groups compared to baseline (p<0.05). Postprocedural cTFC was found significantly lower in the direct stent arm compared to conventional stenting (p<0.001). Both during and after the procedure the complication rate and procedural time were lower in the direct stenting arm. Direct stenting provides better immediate coronary blood flow and is a safe and feasible method compared with conventional stenting in patients with AMI. Improvement in coronary blood flow measured by the corrected TIMI frame count method may suggests a significant reduction of microvascular injury.

Assessment of atrial electromechanical delay by tissue Doppler echocardiography in obese subjects.

Our aim was to evaluate whether atrial electromechanical delay measured by tissue Doppler imaging (TDI), which is an early predictor of atrial fibrillation (AF) development, is prolonged in obese subjects. A total of 40 obese and 40 normal‐weight subjects with normal coronary angiograms were included in this study. P‐wave dispersion (PWD) was calculated on the 12‐lead electrocardiogram (ECG). Systolic and diastolic left ventricular (LV) functions, inter‐ and intra‐atrial electromechanical delay were measured by TDI and conventional echocardiography. Inter‐ and intra‐atrial electromechanical delay were significantly longer in the obese subjects compared with the controls (44.08 ± 10.06 vs. 19.35 ± 5.94 ms and 23.63 ± 6.41 vs. 5.13 ± 2.67 ms, P < 0.0001 for both, respectively). PWD was higher in obese subjects (53.40 ± 5.49 vs. 35.95 ± 5.93 ms, P < 0.0001). Left atrial (LA) diameter, LA volume index and LV diastolic parameters were significantly different between the groups. Interatrial electromechanical delay was correlated with PWD (r = 0.409, P = 0.009), high‐sensitivity C‐reactive protein (hsCRP) levels (r = 0.588, P < 0.0001). Interatrial electromechanical delay was positively correlated with LA diameter, LA volume index, and LV diastolic function parameters consisting of mitral early wave (E) deceleration time (DT) and isovolumetric relaxation time (IVRT; r = 0.323, P = 0.042; r = 0.387, P = 0.014; r = 0.339, P = 0.033; r = 0.325, P = 0.041; respectively) and, negatively correlated with mitral early (E) to late (A) wave ratio (E/A) (r = −0.380, P = 0.016) and myocardial early‐to‐late diastolic wave ratio (Em/Am) (r = −0.326, P = 0.040). This study showed that atrial electromechanical delay is prolonged in obese subjects. Prolonged atrial electromechanical delay is due to provoked low‐grade inflammation as well as LA enlargement and early LV diastolic dysfunction in obese subjects.

Significance of serum trace element status in patients with rheumatic heart disease: a prospective study.

It is known that certain trace elements can affect various heart diseases. In this study, we aimed to evaluate the changes in concentrations of certain serum trace elements in patients with chronic rheumatic heart disease (RHD). Serum analysis of selenium (Se), zinc (Zn), and copper (Cu) trace elements was assayed by atomic absorption spectrophotometry. RHD patients had significantly lower serum concentrations of Se and Zn than control subjects (p<0.05 and p<0.001, respectively). However, the serum Cu concentration was significantly higher in RHD patients than in controls (1.93±0.59 μg/L vs 1.06±0.29 μg/L; p<0.001). Similarly, the Cu/Zn ratio in RHD patients was higher than in control subjects (4.70±0.92 vs 1.68±0.45; p<0.001). Additionally, no significant correlation was found among these trace element concentrations and the functional capacity classes (p>0.05). RHD patients had decreased serum Se and Zn element concentrations and increased serum Cu element concentration. We suggest that Se and Zn deficiency might be contributory factors in the development of rheumatic heart disease, and a high Cu concentration and a high Cu/Zn ratio might reflect an ongoing inflammatory process in this disease.

Elevated Oxidative Stress Markers and its Relationship With Endothelial Dysfunction in Behçet Disease

Behçet’s disease (BD) is a multisystemic disorder characterized by endothelial dysfunction. However, the relationship between oxidative stress and endothelial function has not been clearly shown. We investigated the relationship between oxidative stress markers and endothelial function in patients with BD. Patients with BD (n = 40) having active disease and sex- and age-matched 40 controls were included. Endothelial function was assessed by flow-mediated dilatation (FMD) technique. Serum gamma-glutamyltransferase (GGT) and high-sensitive C-reactive protein levels (hsCRP) were measured in all participants. Brachial artery FMD was significantly lower in patients with BD than in controls. Gamma-glutamyltransferase and hsCRP levels were higher in patients with BD than in controls. Also, GGT and hsCRP levels were inversely correlated with endothelial function. Oxidative stress markers are elevated in patients with BD having active disease. This may be one of the reasons behind the vasculitis in active BD.