Özge Kurmuş

P-wave duration changes and dispersion in preeclampsia

OBJECTIVE The purpose of this research was to study P wave parameters to determine the association between preeclampsia and future cardiovascular risk and to study the possible correlation between P waves and severity of preeclampsia. STUDY DESIGN In this case-control study 58 pregnant women with preeclampsia and 30 normal pregnant women were compared by measuring maximum and minimum P-wave durations and P-wave dispersion (Pd) in the late third trimester. RESULTS Minimum P wave values were lower and Pd values were higher, both significantly, in the preeclampsia groups than in the control group. In addition, the Pd values of the severe preeclampsia group were higher compared to that of the mild preeclampsia group. CONCLUSION Preeclampsia predisposes the patient to future cardiovascular complications including atrial or ventricular arrhythmias, but validated tools to assess the risks are yet not available. P-wave duration and Pd constitute a recent contribution to the field of noninvasive electrocardiology. Our data clearly demonstrated that minimum P wave and Pd values were significantly altered in preeclamptic pregnant women when compared to the controls. This important association can be used to screen women for increased risk in order to better target counseling regardinglifestyle modifications and to follow up and manage women with a history of preeclampsia more closely.

Association between carotid intima-media thickness and presence of coronary artery disease in chronic obstructive pulmonary disease patients

Objective: Chronic obstructive pulmonary disease (COPD) is a risk factor for cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is the sign of subclinical atherosclerosis. Therefore, the aim of this study was to evaluate whether CIMT measurement is related with significant coronary artery disease (CAD) in patients with COPD, similar to those without COPD. Methods: One hundred and eight patients with previously diagnosed COPD and 78 patients without COPD who underwent coronary angiography (CAG) were enrolled in this prospective cross-sectional study. Carotid artery ultrasonography was performed on all patients after coronary angiography by another operator who was blind to the CAG results. The patients were divided into four subgroups as follows: group 1: COPD (-) and CAD (-); group 2: COPD (-) and CAD (+); group 3: COPD (+) and CAD (+); and group 4: COPD (+) and CAD (-). Patients with previous coronary revascularization, carotid artery disease, and lung disease other than COPD were not enrolled in this study. The student’s t-test, chi-square analysis, multiple logistic regression analysis, and receiver operating characteristic (ROC) curve were used for statistical analysis. Results: CIMT was found to be highest in patients with both significant CAD and COPD (group 3) (p<0.05). Among the 108 COPD patients, the odds ratio associated with the CIMT >1.25 mm to predict CAD was 12.4. The area under the ROC curve for a cut-off value of 1.25 mm for CIMT to predict CAD in COPD patients was calculated as 0.913, with a sensitivity of 89.7% and specificity of 86.7%. Conclusion: CIMT has a predictive value for the presence of CAD in patients with COPD. Further studies are needed to validate our results. (Anatol J Cardiol 2016; 16: 601-7)

Association between admission mean platelet volume and ST segment resolution after thrombolytic therapy for acute myocardial infarction.

OBJECTIVE Mean platelet volume (MPV), one of the indices of platelet reactivity has been shown to be related to impaired angiographic reperfusion in ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty or thrombolytics. However data regarding MPV and its association with ST-segment resolution; an indicator of epicardial and tissue level reperfusion in the setting of STEMI are limited. In this study, we aimed to investigate whether MPV on admission is associated with ST-segment resolution in STEMI patients treated with thrombolytics. METHODS We retrospectively evaluated 232 consecutive patients with a diagnosis of first STEMI who were administered thrombolytic therapy within 12 hours of onset of chest pain. ST segment resolution based on baseline and 90 minute electrocardiographies were measured. Patients were grouped into two as with <50% and ≥50% ST-segment resolution. Admission MPV was measured and compared between two groups. RESULTS Admission MPV was higher in patients with <50% ST-segment resolution than patients with ≥50% ST-segment resolution (9.9±1.3 fL vs. 8.5±1.1 fL respectively, p<0.001). The receiver operating characteristic analysis yielded a cut-off value of 9.3 fL to predict ST-segment resolution, with sensivity and specifity being 66.7% and 77.9%, respectively. In-hospital mortality rate was high in patients with <50% ST -segment resolution (p=0.002). CONCLUSION High MPV on admission in STEMI patients treated with thrombolytics is associated with impaired ST segment resolution.

Forced expiratory volume in one second can predict SYNTAX score in patients with chronic obstructive pulmonary disease

BACKGROUND The SYNTAX score is an angiographic score that predicts coronary artery disease (CAD) complexity. It has been shown to be useful for decision making about percutaneous coronary intervention or coronary artery bypass grafting among patients with CAD. Higher SYNTAX scores are indicative of more complex disease. Chronic obstructive pulmonary disease (COPD) is characterised by limitation of airflow. Measurement of forced expiratory volume in one second (FEV1) in spirometry is used for diagnosis and to determine the severity of the disease. AIM To evaluate the relationship between FEV1 and SYNTAX score in patients with COPD. METHODS Seventy-eight patients with a previous diagnosis of COPD and 48 patients without COPD were enrolled. Spirometry and coronary angiography were performed in all patients. SYNTAX score was calculated and compared between the two groups. The correlation between FEV1 and SYNTAX score was analysed. RESULTS SYNTAX score was higher in patients with COPD than in patients without COPD (23.22 ± 12.10 vs. 17.92 ± 11.21, respectively; p = 0.013). Multivariate analysis demonstrated that COPD was independently predictive for intermediate and high SYNTAX score (odds ratio 4.833; 95% confidence interval 2.228-10.485; p < 0.001). Mean FEV1 (% predicted) was 64.7 ± 11.4 and negatively correlated with SYNTAX score in COPD group (r = -0.266 and p = 0.018). The receiver operating characteristic analysis yielded a cutoff value of 65.5 for the FEV1 to predict SYNTAX score ≥ 23, with sensitivity and specificity being 78.6% and 70%, respectively. CONCLUSIONS COPD is a predictor of higher SYNTAX scores. FEV1 is associated with more severe and complex CAD.

Novel indexes of arrhythmogenesis in preeclampsia: QT dispersion, Tp-e interval, and Tp-e/QT ratio

OBJECTIVE There is increasing evidence that preeclampsia (PE) may also be a risk factor for future cardiovascular diseases (CVDs), including arrhythmia. In this study we aimed to evaluate the association between PE and ventricular repolarization using novel electrocardiogram markers: QT interval duration, Tp-e interval, and Tp-e/QT ratio. MATERIALS AND METHODS In this controlled cross-sectional study sixty-four pregnant women with PE (31 with mild and 33 with severe disease) and 32 healthy women with uncomplicated pregnancies in the third trimester were compared by measuring QT parameters, Tp-e interval, and Tp-e/QT ratio. RESULTS Tp-e interval and Tp-e/QT ratio values were significantly higher in both the mild and severe PE groups compared to the healthy pregnant group. CONCLUSION Prevention of CVD requires that patients be aware of their risk factors, be educated about their risk, and perhaps most importantly perceive them to be at risk. In this study, we documented that PE has a significant effect on ventricular repolarization. This alteration could, in part, explain the increased cardiovascular risk in women with a history of PE. This important association can be used to screen women for increased risk in order to better target counseling regarding lifestyle modifications and to follow up and manage women with a history of hypertensive disease of pregnancy more closely.

Evaluation of mean platelet volume in patients with different degree of coronary collateral develop

1 Ozge Kurmus1, Turgay Aslan1, Ozgur Kirbas2, Cemal Koseoglu3, Tolga Han Efe4, Mehmet Bilge5 1Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, 2Department of Cardiology, Yuksek Ihtisas University, Ankara, 3Department of Cardiology, Tokat State Hospital, Tokat, 4Department of Cardiology, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, 5Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey Mean platelet volume and coronary collaterals Evaluation of mean platelet volume in patients with different degree of coronary collateral development

Impact of Admission Blood Glucose on Coronary Collateral Flow in Patients with ST-Elevation Myocardial Infarction

In patients with acute myocardial infarction, glucose metabolism is altered and acute hyperglycemia on admission is common regardless of diabetes status. The development of coronary collateral is heterogeneous among individuals with coronary artery disease. In this study, we aimed to investigate whether glucose value on admission is associated with collateral flow in ST-elevation myocardial infarction (STEMI) patients. We retrospectively evaluated 190 consecutive patients with a diagnosis of first STEMI within 12 hours of onset of chest pain. Coronary collateral development was graded according to Rentrop classification. Rentrop 0-1 was graded as poor collateral development, and Rentrop 2-3 was graded as good collateral development. Admission glucose was measured and compared between two groups. Mean admission glucose level was 173.0 ± 80.1 mg/dl in study population. Forty-five (23.7%) patients had good collateral development, and 145 (76.3%) patients had poor collateral development. There were no statistically significant differences in demographic characteristics between two groups. Three-vessel disease was more common in patients with good collateral development (p=0.026). Mean admission glucose level was higher in patients with poor collateral than good collateral (180.6 ± 84.9 mg/dl versus 148.7 ± 56.6 mg/dl, resp., p=0.008). In univariate analysis, higher admission glucose was associated with poor collateral development, but multivariate logistic regression analysis revealed a borderline result (odds ratio 0.994, 95% CI 0.989–1.000, p=0.049). Our results suggest that elevated glucose on admission may have a role in the attenuation of coronary collateral blood flow in acute myocardial infarction. Further studies are needed to validate our results.

The Effects of Continuous Positive Airway Pressure on Premature Ventricular Contractions and Ventricular Wall Stress in Patients with Heart Failure and Sleep Apnea

Background We aimed to investigate the effects of continuous positive airway pressure (CPAP) treatment on electrocardiography (ECG), premature ventricular contraction load on 24-hour Holter recordings, and implantable cardioverter defibrillator (ICD) shocks in patients with obstructive sleep apnea syndrome (OSAS) and heart failure. Methods Patients with heart failure and ICD and patients with newly diagnosed OSAS were divided into two groups according to CPAP treatment. To compare the impact of CPAP on ECG parameters, both baseline and 6-month ECG, 24-hour Holter ECG, ambulatory blood pressure monitoring, echocardiography, polysomnography, and laboratory parameters were collected. Results CPAP treatment significantly reduced the frequency of premature ventricular contractions, T-peak to T-end, corrected QT, corrected QT dispersion, and T-peak to T-end/corrected QT ratio in the study group (p < 0.001 for all). Although the baseline NT-pro-BNP levels were similar between study and control groups, after six months, the NT-pro-BNP levels of the study group were significantly lower than that of the control group (39.18 ± 7.57 versus 46.11 ± 7.65; p < 0.001). Conclusions CPAP treatment in patients with heart failure and ICD and in patients with newly diagnosed OSAS may have beneficial effects on premature ventricular contractions and electrocardiographic arrhythmia indices and NT-pro-BNP levels. However, these results are needed to be clarified with further studies.

Clinical Utility of An Implantable Cardioverter-Defibrillator Lead With A Floating Atrial Sensing Dipole: A Single-Center Experience

Background: Single-chamber ICD systems with the ability to sense the atrium have been developed. We describe the operation characteristics, atrial and ventricular sense performance of the lead, atrial and ventricular tachyarrhythmia recordings, and appropriate and inappropriate shock treatments in patients who receive a single lead ICD with a floating atrial sensing dipole in our center. Methods: We retrospectively analyzed the data of 58 patients (44 male, 59.3 ± 4.41 years) who were implanted with a Lumax 540 VR-T DX device with a Linox Smart S DX lead. The pacemaker records of the patients were analyzed monthly for 12 months. All of the recorded tachyarrhythmia episodes were examined by 2 cardiologists and atrial/ventricular discrimination was performed. We also compared with SMART algorithm. Results: A total of 24 tachycardia episodes with rapid ventricular response were detected in 7 patients. Three of them, which were in the VF zone, were treated by ICD appropriately without using the SMART algorithm. Nine of 21 tachycardia episodes were evaluated as VT by SMART algorithm. The visual analysis showed that VT attacks were detected correctly by the algorithm. Twelve tachycardia episodes were evaluated as SVT by the algorithm. No treatment was applied by ICD. It was confirmed in visual analysis. A total of 38 atrial tachycardia episodes were detected in 8 patients. Visual analysis confirmed that these attacks were correctly detected by the SMART algorithm. Conclusions: Single lead ICD systems with atrial dipole provide reliable atrial recordings during sinus rhythm and arrhythmias.

The Importance of Inflammation Markers in Heart Failure Patients With Appropriate Or Inappropriate ICD Shock

Background: C-reactive protein (CRP), neutrophil lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) are associated with the prognosis of cardiovascular diseases such as coronary artery disease, acute myocardial infarction, and heart failure. However, their prognostic significance is unknown in the heart failure patients with implantable cardioverter defibrillator (ICD) devices. Objective: The aim of this study is to evaluate the levels of inflammation markers (CRP, NLR, and PLR) in patients with ICD who have received no shock during 3 years of follow-up and in those who have received appropriate or inappropriate shock, and to determine importance of inflammatory markers in ICD patients who received shock delivery. Results: There was a statistically significant difference between the groups in terms of gender and age (p=0.013, p<0.001, respectively). Patients who have received appropriate or inappropriate shock were older and mostly male. There was no statistically significant difference between groups in terms of mean NLR and PLR values (p>0.05). In ICD patients who have received appropriate or inappropriate shock, the highest AUC value was found for CRP in the receiver operating characteristic curve assessment. Conclusion: Our results show that the NLR, PLR, WBC values cannot be used to determine ICD shock while it suggests CRP may be.