Övsev Dörtlemez

Effects of left ventricular systolic dysfunction on left atrial appendage and left atrial functions in patients with chronic nonvalvular atrial fibrillation.

Objective — It has been claimed that left ventricular (LV) systolic dysfunction impairs left atrial (LA) and left atrial appendage (LAA) functions. In this study, we compared the LA and LAA function parameters in patients with chronic nonvalvular atrial fibrillation (AF) with and without LV systolic dysfunction. Methods and results — The study population consisted of 28 patients with chronic nonvalvular AF. Group I consisted of 12 patients with LV systolic dysfunction (mean age: 61 ± 14 years; LV ejection fraction: 44 ± 6%), group II of 16 patients with normal LV systolic function (mean age: 52 ± 15 years; LV ejection fraction: 65 ± 3%). LV ejection fraction (EF) was measured by echocardiography utilizing bi-plane area length method.The following LA and LAA transoesophageal echocardiography parameters were obtained: 1) LA diameter, 2) LAA ejection velocity, 3) LAA filling velocity, 4) LAA ejection fraction, 5) pulmonary venous (PV) systolic velocity, 6) PV diastolic velocity, 7) PV systolic velocity/diastolic velocity ratio.The left atrium diameter was significantly larger in group I than in group II (4.7 ± 0.7 cm vs. 3.8 ± 0.6 cm, p < 0.05). The LAA ejection velocity and LAA ejection fraction were significantly lower in group I than in group II (22.6 ± 15.5 cm/s vs 37.5 ± 11.3 cm/s and 26.9 ± 20.8% vs. 41.3 ± 10.9%, p < 0.05 for both comparisons). The PV systolic velocity and PV systolic velocity/diastolic velocity ratio were significantly smaller in group I than in group II (26.2 ± 14.8 cm/s vs. 51.5 ± 22 cm/s and 0.7 ± 0.6 vs. 1.2 ± 0.5, p < 0.05 for both comparisons). Although decreased LAA filling and PV diastolic velocities were determined in group I, no significant difference existed between groups I and II.Thrombus and/or spontaneous echo contrast (SEC) in the LA and/or LAA were more frequent in group I (75% vs. 18%, p < 0.05). Conclusion — These results indicate that LV systolic dysfunction impairs various LA and LA function parameters and is associated with an increased frequency of SEC and/or LA thrombus in patients with chronic nonvalvular AF.

Medium-term follow-up of intermediate coronary stenoses left unrevascularized based on myocardial fractional flow reserve findings.

Objective — Coronary stenoses of intermediate severity create difficulties in decision making when revascularization is concerned. Myocardial fractional flow reserve (mFFR), an accurate tool to identify physiological significance of individual coronary stenoses, may help solve this problem. Methods and results — Fifty-eight intermediate (30-70%) coronary stenoses in 51 patients (mean age 54.4 ± 8.9 years, 9 women) were left unrevascularized because of normal (≥ 0.75) mFFR findings and the patients were prospectively followed with regard to the occurrence of death, myocardial infarction and target vessel revascularization.The mean reference vessel diameter, percent stenosis and mFFR of the intermediate lesions were 3.3 ± 0.3 mm, 46.8 ± 9.2% and 0.86 ± 0.05, respectively. Of the 58 intermediate lesions, 20 (34%) were associated with perfusion defects on thallium scan. Significant (> 70%) disease in addition to the one with the intermediate stenosis was present in 1 coronary artery in 24 (47%), and 2 coronary arteries in 6 (12%) patients and angioplasty of at least one significant stenosis was performed at the initial evaluation in 18 (35%) patients. Follow-up for a mean of 16.6 ± 6.6 months disclosed no death or myocardial infarction.Target vessel revascularization was performed in 3 (6%) patients at a mean of 4 ± 2.6 months. A control angiogram, which was performed in 12 of 18 patients who had undergone angioplasty at the initial evaluation revealed restenosis in 3 (25%) patients with no significant angiographic changes in the target intermediate stenoses. Anginal status was found to be significantly improved at follow-up. Conclusions — In this study, we found that intermediate coronary stenoses with an mFFR ≥ 0.75 have a favourable medium-term clinical outcome with respect to major cardiac adverse events when left unrevascularized based on mFFR findings.

Coronary artery to left ventricular fistula: case report and review of the literature.

In this report, an unusual case with a multiple plexiform type of coronary artery-to-left ventricular fistula and coexisting atherosclerotic involvement of the contralateral coronary artery is described and the pertinent literature is reviewed briefly.

Frequency of cardiac troponin-T elevation after successful direct stenting

Direct stenting (stenting without balloon predilation) is a novel approach in percutaneous treatment of coronary artery lesions. This approach may also significantly lower the rate of procedural ischaemic complications by reducing aggression to the vessel wall and immediately sealing the dissections created due to balloon inflation by the endoprosthesis. However, the incidence of minor myocardial infarction after direct stenting is unknown. The purpose of this study was to measure cTnT, creatine kinase and its isoform, CK-MB after apparently successful elective stent implantation without balloon predilation. Enzyme levels were measured just before and 16 hours after the procedures. A second-generation commercial ELISA cTnT assay (Boehringer Mannheim Corporation) was used to measure cTnT with a cutoff of 0.1 ng/dl. There was no abnormality in all three enzymes before the procedure. CTnT was elevated in 6 patients (13 6%), CK and CK-MB were elevated in 1 (2.3%) patient at 16 hours after the procedure. Both CK and CK-MB elevation were observed in the patient with side branch occlusion. In all others cTnT measurements in addition to CK-MB measurements are needed to detect this minor myocardial damage.To the best of our knowledge this is the first report evaluating the incidence of myocardial injury after direct stenting. Direct stenting by avoiding balloon-induced complications may decrease procedural myocardial necrosis. Randomized studies with larger patient populations should be conducted to compare this approach with conventional stenting. CTnT measurements in addition to CKMB measurements are essential in detecting this minor myocardial damage.