Özgül Malçok Gürel

Fragmented QRS predicts the arrhythmic events in patients with heart failure undergoing ICD implantation for primary prophylaxis: more fragments more appropriate ICD shocks.

Fragmented QRS complex (fQRS) is associated with cardiovascular outcomes in various patient populations. Although there were clinical studies investigating the association of fQRS with arrhythmic events in patients with systolic heart failure, the results were conflicting regarding the association of implantable cardioverter defibrillator (ICD) shocks and fQRS. In this study, we aimed to evaluate the association between the presence and extent of fQRS with appropriate ICD shocks and/or all‐cause mortality.

Usefulness of Preprocedural Serum Uric Acid Level to Predict Restenosis of Bare Metal Stents

Serum uric acid (SUA) level is known as a significant predictor for cardiovascular diseases, partly through increased inflammatory response and smooth muscle cell proliferation. Inflammation and smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relation between SUA and ISR has not been studied. The aim of the present study was to investigate the predictive value of preprocedural SUA on the development of ISR in patients who undergo coronary bare-metal stent implantation. Clinical, biochemical, and angiographic data from 708 consecutive patients (mean age 60.3 ± 9.3 years, 71% men) who had undergone bare-metal stent implantation and additional control coronary angiography for stable or unstable angina pectoris were analyzed. Patients were divided into tertiles on the basis of preprocedural SUA levels. Stent restenosis was observed in 54 patients (23%) in the lowest tertile, in 79 (34%) in the middle tertile, and in 109 (46%) in the highest tertile (p <0.001). Using multiple logistic regression analysis, diabetes mellitus, smoking, high-density lipoprotein cholesterol, stent length, C-reactive protein level, and preprocedural SUA level emerged as independent predictors of ISR. On receiver-operating characteristics curve analysis, SUA level >5.5 mg/dl had 75% sensitivity and 71% specificity (area under the curve 0.784, p <0.001) in predicting ISR. In conclusion, higher preprocedural SUA is a powerful and independent predictor of bare-metal stent restenosis in patients with stable and unstable angina pectoris.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa in a patient with Takayasu's arteritis

An asymptomatic 35-year-old woman with Takayasu’s arteritis, moderate aortic regurgitation, left ventricular (LV) hypertrophy and hypertension was referred to the echocardiography laboratory at the Yuksek Ihtisas Hospital (Ankara, Turkey) for a routine clinical follow-up. Transthoracic echocardiography revealed a suspected aneurysm in the subaortic region adjacent to the left sinus of Valsalva (Figure 1A). Subsequent three-dimensional real-time transthoracic echocardiography clearly demonstrated a pseudoaneurysm in the mitral-aortic intervalvular fibrosa (MAIVF) (Figure 1B). Specific echocardiographic features identified the lesion as a pseudoaneurysm: expansion in systole and collapse in diastole (Figure 1C), and communication between the sac and the LV outflow tract (Figure 1B). Figure 1) A Transthoracic echocardiography showing suspected aneurysm in the subaortic region adjacent to the left sinus of Valsalva (arrowhead). B Three-dimensional, real-time transthoracic echocardiography showing a pseudoaneurysm in the mitral-aortic intervalvular ... The MAIVF is the fibrous junction between the noncoronary and left coronary cusps of the aortic valve and the anterior mitral leaflet (1). Most pseudoaneurysms of the MAIVF form as complications of aortic valve endocarditis or aortic root surgery (2). The prognosis is grave because of the high risks of rupture, peripheral embolization and destruction of the aortic or mitral valves (1–3). Of note, the patient had not undergone cardiac surgery, and tests showed no evidence of infective endocarditis. It is known that a pronounced shear effect on tissues near MAIVF can lead to pseudoaneurysm formation (3). In Takayasu’s arteritis, the MAIVF is exposed to high LV intracavitary pressure due to elevated central aortic pressure. Pseudoaneurysm of the MAIVF is unusual in the setting of Takayasu’s arteritis. Surgical correction is life-saving, so clinicians should keep in mind that such lesions can occur in this patient group. Three-dimensional real-time transthoracic echocardiography is an excellent, noninvasive way to accurately diagnose pseudoaneurysms of the MAIVF.

Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease

OBJECTIVE: The aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. METHODS: The study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing <50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≥50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. RESULTS: The average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. CONCLUSION: We showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases.

Myocardial Tissue Perfusion Predicts the Evolution of Fragmented QRS in Patients with ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS.

Association between Red Blood Cell Distribution Width and Coronary Artery Calcification in Patients Undergoing 64-Multidetector Computed Tomography

Background and Objectives The red blood cell distribution width (RDW) has been found to be associated with cardiovascular morbidity and mortality. The objective of this study was to determine whether the RDW measures are associated with the coronary artery calcification score (CACS) in patients who did not present with obvious coronary heart disease (CHD). Subjects and Methods A total of 527 consecutive patients with a low to intermediate risk for CHD but without obvious disease were enrolled in this study. The study subjects underwent coronary computerized tomography angiography and CACS was calculated. The patients were divided into two groups based on CACS: Group I (CACS≤100) and Group II (CACS>100). The two groups were compared in terms of classic CHD risk factors and haematological parameters, particularly the RDW. Results Group I patients were younger than Group II patients. The Framingham risk score (FRS) in patients of Group II was significantly higher than that in patients of Group I. Group II patients had significantly elevated levels of haemoglobin, RDW, neutrophil count, and neutrophil/lymphocyte ratio compared with Group I patients. CACS was correlated with age, RDW, and ejection fraction. In the multivariate analysis, age, RDW, and FRS were independent predictors of CACS. Using the receiver-operating characteristic curve analysis, a RDW value of 13.05% was identified as the best cut-off for predicting the severity of CACS (>100) (area under the curve=0.706). Conclusion We found that the RDW is an independent predictor of the CACS, suggesting that it might be a useful marker for predicting CAD.

CA 125 levels and left ventricular function in patients with end-stage renal disease on maintenance hemodialysis

Abstract Purpose: The aim of this study was to analyze associations between serum cancer antigen 125 (CA 125) levels and left ventricular (LV) function in patients with end-stage renal disease on maintenance hemodialysis (HD). Methods: CA 125 levels, pro-brain natriuretic peptide (pro-BNP) and biochemical parameters were measured, and echocardiography was performed for 110 patients and 47 healthy controls. Results: The mean CA 125 level in patients, 38.78 ± 35.48 U/mL, was significantly higher than that found in healthy controls (9.20 ± 4.55 U/mL; p = 0.003). Patients with elevated CA 125 levels (n = 40) had significantly lower levels of albumin and reduced relative wall thickness, LV ejection fraction (EF) and fractional shortening but significantly higher levels of pro-BNP and a greater left ventricular end-diastolic diameter (LVEDd) and -systolic diameter (LVESd). CA 125 levels were positively correlated with pro-BNP (r = 0.596, p < 0.05) and C-reactive protein (CRP) levels (r = 0.439, p < 0.05), as well as LVEDd (r = 0.599, p < 0.001), LVESd (r = 0.750, p < 0.001) and LV mass index (r = 0.378, p < 0.05). In contrast, serum CA 125 levels were negatively correlated with albumin (r = −0.513, p < 0.05) and hemoglobin (r = −0.475, p < 0.05) as well as the EF (r = −0.878, p < 0.0001). A depressed EF (β = −1.121, p < 0.0001) and increased CRP levels (β = 0.247, p = 0.035) were independent predictors of high CA 125 levels in the whole group in the multivariate-model. Conclusions: Our study is the first to demonstrate an association between serum CA 125 levels and LV systolic dysfunction via inflammation in patients on maintenance HD.

Association of ambulatory arterial stiffness index with sEPCR in newly diagnosed hypertensive patients

Abstract Aim: Increased arterial stiffness is strongly associated with cardiovascular diseases, while thrombotic events are more common than hemorrhagic events in hypertensive patients. Markers of a hypercoagulable state may also predict future cardiovascular events in hypertensive patients. Here, we speculated that increased arterial stiffness might lead to the development of a hypercoagulable state that can play a role in the thrombotic complications of hypertension. Soluble endothelial protein C receptor (sEPCR) is one such marker of hypercoagulation. The ambulatory arterial stiffness index (AASI) could be accepted as a non-invasive measure of arterial stiffness. The aim of this study was to investigate association of AASI with levels of sEPCR in newly diagnosed hypertensive patients. Materials and methods: The study included 263 newly diagnosed essential hypertensive patients and 55 healthy normotensive controls. All subjects underwent 24 h ambulatory blood pressure monitoring (ABPM); the AASI was derived from ABPM tracings. Plasma sEPCR was measured by ELISA. Results: Hypertensive patients (n = 263) had higher AASI, C-reactive protein (CRP) and sEPCR versus the normotensive healthy group (n = 55). Univariate analysis showed that AASI was positively associated with age (r = 0.212, p <  0.001) body mass index (r = 0.412, p < 0.001), pulse pressure (r = 0.350, p < 0.001), plasma sEPCR (r = 0.894, p < 0.001), 24-h heart rate (r = 0.176, p = 0.001) and inversely related to high-density lipoprotein (HDL) (r = −0.293, p < 0.001). Multivariate analyses revealed that sEPCR and HDL are independently correlated to AASI. Conclusion: We suggest that increased AASI is associated with elevated sEPCR. It might be responsible for subsequent thrombotic events in newly diagnosed hypertensive patients.

A coronary proatherosclerotic marker: Pregnancy-associated plasma protein A and its association with coronary calcium score and carotid intima-media thickness

BACKGROUND Atherosclerosis, a chronic inflammatory disorder of the arteries, is responsible for the greatest number of deaths in westernized societies, with numbers increasing at a marked rate in developing countries. Coronary calcium score (CCS), carotid intima-media thickness (CIMT) and pregnancy-associated plasma protein A (PAPP-A) are predictors for the development of atherosclerosis. OBJECTIVES This study was aimed to investigate the relationship between CCS, CIMT and PAPP-A for earlier diagnosis of atherosclerosis. MATERIAL AND METHODS A total of 99 patients were included in the study. Coronary computerized tomography (CT) angiography was performed on all patients. The calcium scoring technique was performed using a sequential scanning mode. CIMT measurement was done through the area 1 cm distal of the bulbus arteriosus with carotid Doppler ultrasound. PAPP-A values were analyzed by double immunoenzymatic technique. RESULTS Out of 99 patients, 63 were found with coronary atherosclerosis using multislice computed tomography (MSCT) coronary angiography. When the cut-off point for CCS was taken to be 0.40, the sensitivity of this parameter was 97% and its specificity was 68.3%. When the cut-off point for CIMT was taken to be 0.60, the sensitivity and the specificity of these parameters were 75.0% and 87.3%, respectively, for the right measurements and 75.0% and 79.4%, respectively, for the left measurements. CONCLUSIONS This data support the conclusion that PAPP-A, like CCS and CIMT, is a parameter that can be used to detect subclinical atherosclerosis.

A Case Report of Three Dimensional Transthoracic Echocardiographic View of Acute Proximal Type Aortic Dissection

A 67 year-old female patient was admitted to our emergency room with the complaint of severe and sudden onset tearing like chest pain lasting for an hour. Immediately performing twodimensional transthoracic echocardiography (2DTTE), pericardial effusion and an undulating intimal flap within the aortic lumen starting from the non-coronary cuspid were visualized. Ascending aorta was 7.6 cm in diameter. Real-time three-dimensional (RT 3D) TTE confirmed the diagnosis. Once the diagnosis of acute proximal type aortic dissection is suspected which modality to be chosen depends on clinical status of the patient and technical availability of the hospital. Non-invasive diagnostic modalities like contrast enhanced computed tomography (CECT), magnetic resonance imaging (MRI) may be preferred over invasive aortography. As transesophageal echocardiography (TEE) is a semi-invasive procedure and is mostly used intraoperatively, TTE may be preferred instead of TEE. RT 3DTTE is a helpful equipment in confirming the diagnosis of aortic dissection by 2DTTE. RT 3DTTE is advantageous in terms of accessibility and applicability at bedside and being a non-invasive procedure.