Omer Senarslan

Usefulness of fragmented QRS in hypertensive patients in the absence of left ventricular hypertrophy

In the absence of left ventricular hypertrophy, importance of fragmented QRS complex (fQRS) in individuals with hypertension is unknown. The authors aimed to evaluate the relationship between blood pressure levels and fQRS in the absence of left ventricular hypertrophy. A total of 548 never‐treated patients who underwent 24‐hour ambulatory blood pressure monitoring were enrolled. The frequency of fQRS was significantly higher in patients with hypertension than normotension (36.4% vs 17.6%, P<.05). Multivariate logistic regression analysis revealed that systolic blood pressure is significantly associated with presence of fQRS on electrocardiography (odds ratio, 0.931; 95% CI, 0.910–0.9521 [P<.001]) even after adjusting for other confounding factors. Receiver operating characteristic analysis revealed a cutoff value of 147.65 mm Hg for systolic blood pressure to predict presence of fQRS (sensitivity: 51%, specificity: 99%, area under the curve=0.764; 95% CI, 0.717–0.811 [P<.001]). fQRS may be a sign of increased blood pressure and may predict higher fibrotic burden in patients with hypertension.

Left ventricular haematoma mimicking lateral wall myocardial infarction secondary to percutaneous coronary intervention.

Summary Dissecting intra-myocardial haematoma is a rare disease and a potentially fatal complication after cardiac surgery. Patients with previous heart surgery have more risk for dissecting intra-myocardial haematoma after percutaneous coronary intervention. Management of this issue is challenging. We describe a rare case of a 63-year-old woman with a left ventricular wall-dissecting intra-myocardial haematoma, which developed 30 minutes after percutaneous coronary intervention. The patient was treated conservatively, with a successful outcome.

Mean Platelet Volume is Associated with Inadequate Reperfusion Detected by Angiography in Patients with Successful Fibrinolytic Therapy

Mailing Address: Mehmet Eyuboglu 4025 Sokak Camlik Girisi, N:38. Postal Code: 35170. Karabaglar, Izmir – Turkey E-mail: mhmtybgl@gmail.com Mean Platelet Volume is Associated with Inadequate Reperfusion Detected by Angiography in Patients with Successful Fibrinolytic Therapy Abdurrahman Arslan1, Mehmet Eyuboglu2, Omer Senarslan3, Mehmet Akif Ekinci4, Mustafa Aytek Simsek5, Onder Kirimli6 Bartın State Hospital1, Avrupa Medicine Center2, Sifa University Hospital3, Alfakalp Medicine Center4, Dokuz Eylul University Hospital5, Dokuz Eylul University Hospital6 – Turkey

An unusual coronary artery to coronary artery fistula.

Mehmet Eyuboglu, Faysal Saylık, Ferhat Cuce, Canan Eyuboglu and Omer Senarslan, Department of Cardiology, Special Izmir Avrupa Medicine Center, Karabaglar, Department of Anatomy, School of Medicine, Dokuz Eylul University, Department of Cardiology, School of Medicine, University of SIFA, Buca, İzmir, Department of Cardiology, Van Research and Training Hospital and Department of Radiology, Van Military Hospital, Merkez, Van, Turkey

Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty: which is preferable?

Summary Background Percutaneous balloon mitral valvuloplasty (BMV) is an important option for the treatment of mitral valve stenosis. The crux of this process is choosing the appropriate Inoue balloon size. There are two methods to do this. One is an empirical formula based on the patient’s height, and other is to choose according to the maximal inter-commissural distance of the mitral valve provided by echocardiography. Methods The study, performed between January 2006 and December 2011, included 128 patients who had moderate to severe mitral stenosis and whose valve morphology was suitable for BMV. Patients were randomised into two groups. One group was allocated to conventional height-based balloon reference sizing (the HBRS group) and the other was allocated to balloons sized by the echocardiographic measurement of the diastolic inter-commissural diameter (the EBRS group). Results BMV was assessed as successful in 60 (92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p = 0.03). The mean of the calculated balloon reference sizes was significantly higher in the HBRS than in the EBRS group [26.3 ± 1.2 mm, 95% confidence interval (CI): 26.1–26.6 vs 25.2 ± 1.1, 95% CI: 25.0–25.4, respectively; p = 0.007). Final mitral valve areas (MVA) were larger and mitral regurgitation (MR) > 2+ was less in the EBRS group (p = 0.02 and p = 0.05, respectively). Conclusions EBRS is a method that is independent of body structure. Choosing Inoue balloon size by measuring maximal diastolic annulus diameter by echocardiography for BMV may be an acceptable method for appropriate final MVA and to avoid risk of significant MR.

Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography

Background Only a small proportion of patients referred for coronary angiography with suspected coronary artery disease (CAD) have the diagnosis of obstructive CAD confirmed by the exam. For this reason, further strategies for risk stratification are necessary. Objective To investigate the relationship of the presence of fragmented QRS (fQRS) on admission electrocardiogram with angiographically detected CAD and CAD severity in patients without known vascular diseases and myocardial fibrosis, undergoing first diagnostic coronary angiography. Methods We enrolled 336 consecutive patients undergoing coronary angiography for suspected CAD. The patients were divided into two groups according to the presence or absence of fQRS on admission. We compared the groups regarding the presence and severity of CAD. Results Seventy-nine (23.5%) patients had fQRS on admission. There was not a statistically significant difference between patients with fQRS (41.8%) and non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there was a statistically significant difference between patients with fQRS and non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%, p<0.001) and multi vessel disease (25,3% vs. 5.1%, p<0.001). The frequency of fQRS was significantly higher in patients with SYNTAX score >22 compared to patients with SYNTAX score ≤22. Conclusions Our findings suggest that fQRS may be an indicator of early-stage myocardial damage preceding the appearance of fibrosis and scar, and may be used for risk stratification in patients undergoing first diagnostic coronary angiography

Multiple coronary fistulae to left ventricle, with acute myocardial infarction

A rare case of myocardial infarction secondary to multiple coronary artery fistulae is described. Coronary angiography showed the fistulae originating from the distal septal branch of the left anterior descending artery and distal branches of the right coronary and circumflex arteries, and drained into the left ventricle. A myocardial perfusion scan showed a fixed perfusion defect.

High Protein Diet Increases Thickness of Renal Parenchyma in Resistance-Trained-Individuals

Objectives: Commercial protein powder or supplements are particularly consumed by resistance-trained individuals. For these individuals, an estimated requirement and recommended dietary allowance (RDA) of good quality protein are 0.66 g and 0.83 g per kg body weight (BW) per day, respectively. The aim of the present study is to examine the effect of high protein intake on thickness of renal parenchyma in resistance-trained individuals in long term. Methods: Thirty six healthy resistance-trained male volunteers participated in this study (mean age 26 ± 3.6 years, body mass index 27.1±3.5). Participants were divided into three groups according to daily protein intake/BW: group 1 (n=8): 1.8 g/kg/day, group 2 (n=16): 2.5 g/kg/day and group 3 (n=12): 4 g/kg/day. They have been regularly resistance training on average of 6.5 ± 3.5 hours per week for the last 6 years. Daily protein intake of the subjects was calculated as the sum of dietary intake plus commercially protein powder. Plasma levels of blood urea nitrogen (BUN) and creatinine were measured in venous blood samples. Renal length, width, thickness and cortical thickness were obtained in longitudinal and transverse ultrasonographic scans in prone position by same radiologist. Cortical echogenicity was graded as less than (0), equal to (1) or greater than (2) liver/spleen parenchyma and loss of cortex medulla differentiation (3). Results: Plasma levels of BUN and creatinine were similar in all groups (p > 0.05). Thickness of renal parenchyma in high protein intake (4 g/kg/day) group was significantly higher than in other groups (p < 0.05). There was a significant positive correlation between grade of cortical echogenicity and high protein intake (p < 0.05). There were also a significant positive correlation between renal cortical thickness and high protein intake (p < 0.05). There was no significant correlation between high protein intake and increased levels of creatinine (p > 0.05). Conclusion: The results of this study indicate that high protein intake increases the thickness of renal parenchyma in resistance-trained individuals in long term. Daily protein intake in excessive doses and unsupervised protein powder usage can be harmful and irreversible effects on kidney in resistance-trained individuals long term.

Use of guideliner cathater in saphenous vein graft: A case report

Guideliner catheter (Vascular Solutions, Minneapolis, MN) is a novel, rapid exchange system which allows deep intubation and facilitate equipment delivery through the complex coronary lesions. We describe the use of this device in a percutaneous intervention of a native diagonal lesion through tortious and calcific saphenous vein graft.

Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery.

Patient: Male, 73 Final Diagnosis: Coronary artery thrombosis Symptoms: Angina pectoris • short of breath Medication: — Clinical Procedure: CABG Specialty: Cardiology Objective: Management of emergency care Background: Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. Case Report: We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. Conclusions: In this case report, we emphasize the importance of the TEE during the preoperational period and during CABG, as well as in the preoperative evaluation of pulmonary hypertension.