Sabiye Yilmaz

The relationship between epicardial fat tissue thickness and visceral adipose tissue in lean patients with polycystic ovary syndrome

BackgroundPolycystic ovary syndrome (PCOS) is related to metabolic syndrome, insulin resistance, and cardiovascular metabolic syndromes. This is particularly true for individuals with central and abdominal obesity because visceral abdominal adipose tissue (VAAT) and epicardial adipose tissue (EAT) produce a large number of proinflammatory and proatherogenic cytokines. The present study aimed to determine whether there are changes in VAAT and EAT levels which were considered as indirect predictors for subclinical atherosclerosis in lean patients with PCOS.MethodsThe clinical and demographic characteristics of 35 patients with PCOS and 38 healthy control subjects were recorded for the present study. Additionally, the serum levels of various biochemical parameters were measured and EAT levels were assessed using 2D-transthoracic echocardiography.ResultsThere were no significant differences in mean age (p = 0.056) or mean body mass index (BMI) (p = 0.446) between the patient and control groups. However, the body fat percentage, waist-to-hip ratio, amount of abdominal subcutaneous adipose tissue, and VAAT thickness were higher in the PCOS patient group than in the control group. The amounts of EAT in the patient and control groups were similar (p = 0.384). EAT was correlated with BMI, fat mass, waist circumference, and hip circumference but not with any biochemical metabolic parameters including the homeostasis model assessment of insulin resistance index or the levels of triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein (HDL) cholesterol. However, there was a small positive correlation between the amounts of VAAT and EAT. VAAT was directly correlated with body fat parameters such as BMI, fat mass, and abdominal subcutaneous adipose thickness and inversely correlated with the HDL cholesterol level.ConclusionsThe present study found that increased abdominal adipose tissue in patients with PCOS was associated with atherosclerosis. Additionally, EAT may aid in the determination of the risk of atherosclerosis in patients with PCOS because it is easily measured.

ECG Changes Due to Hypothermia Developed After Drowning: Case Report

SUMMARY Drowning is one of the fatal accidents frequently encountered during the summer and is the most common cause of accidental death in the world. Anoxia, hypothermia, and metabolic acidosis are mainly responsible for morbidty. Cardiovascular effects may occur secondary to hypoxia and hypothermia. Atrial fibrillation, sinus dysrhythmias (rarely requiring treatment), and, in serious cases, ventricular fibrillation or asystole may develop, showing as rhythm problems on electrocardiogram and Osborn wave can be seen, especially during hypothermia. A 16-year-old male patient who was admitted to our hospitals emergency service with drowning is presented in this article. In our case, ventricular fibrillation and giant J wave (Osborn wave) associated with hypothermia developed after drowning was seen. We present this case as a reminder of ECG changes due to hypothermia that develop after drowning. Response to cardiopulmonary resuscitation after drowning and hypothermia is not very good. Mortality is very high, so early resuscitation and aggressive treatment of cardiovascular and respiratory problems are important for life.

Relationship between CHA2DS2-VASc score and atrial electromechanical function in patients with paroxysmal atrial fibrillation: A pilot study

BACKGROUND CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk. METHODS A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score=0, group 1), with moderate risk (score=1, group 2), and with high risk score (score ≥2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions. RESULTS Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12±8.13ml/m(2), 22.36±8.78ml/m(2), 22.89±7.23ml/m(2), p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r=0.428, r=0.456, r=0.451 and p<0.001). Also, LATEV (r=0.397, p=0.016) and LA active emptying volume (LAAEV) (r=0.281, p=0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin≥11ml/m(2) has the highest predictive value for CHA2DS2-VASc score ≥2 (88% sensitivity and 89% specificity; ROC area 0.88, p<0.001, CI [0.76-0.99]). CONCLUSION Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk.

Epicardial Adipose Tissue Thickness in Patients With Subclinical Hypothyroidism and the Relationship Thereof With Visceral Adipose Tissue Thickness

Background Subclinical hypothyroidism (SH) is associated with cardiovascular metabolic syndromes, especially dislipidemia and abdominal obesity. Visceral abdominal adipose tissue (VAAT) and epicardial adipose tissue (EAT) have the same ontogenic origin and produce many proinflammatory and proatherogenic cytokines. We evaluated EAT and VAAT thickness in patients with SH. Methods Forty-one patients with SH and 35 controls were included in the study. Demographical and anthropometric features of both patients and controls were recorded. Thyroid and metabolic parameters were measured. EAT was measured using 2D-transthoracic echocardiography. Results The age and gender distributions were similar in the two groups (P = 0.998 and P = 0.121, respectively). Body mass index (BMI), fat mass, waist circumference (WC), hip circumference (HC), the WC/HC ratio, and the thicknesses of VAAT and abdominal subcutaneous adipose tissue were higher in the case group than the control group (all P values < 0.01). However, both groups had similar EAT thickness (P = 0.532), which was positively correlated with BMI, fat mass, WC, HC, VAAT thickness, abdominal subcutaneous adipose tissue thickness, and serum triglyceride (TG) level (all P values < 0.01). We found no correlation between EAT thickness and thyroid-stimulating hormone (TSH) level, free thyroxine (FT4) level, or low-density lipoprotein-cholesterol (LDL-C) level, and anti-TPO level (all P values > 0.05). We found no difference between the two groups in fasting plasma glucose (FPG) level (P = 0.780), but the levels of LDL-C and TG differed significantly (P = 0.002 and P = 0.026, respectively). The serum TSH level was higher and the FT4 level was lower in the case than the control group (both P values <0.01). Conclusion Increased abdominal adipose tissue thickness in patients with SH is associated with atherosclerosis. To detemine the risk of atherosclerosis in such patients, EAT measurements are valuable; such assessment is simple to perform.

Pulse wave velocity and myocardial performance index in premature ovarian insufficiency

Abstract Objective. Epidemiological studies suggest that women with loss of ovarian function at early ages may be especially burdened by cardiovascular disease (CVD). In this study, we aimed to evaluate pulse wave velocity (PWV) and myocardial performance index (MPI) in patients with premature ovarian insufficiency (POI). Design. We enrolled 51 female patients (mean age 38.9 ± 6.7 years) with POI and 49 healthy subjects (mean age 36.8 ± 5.2 years). All participants underwent a detailed echocardiographic examination and PWV measurement, which is basically the velocity of pulse wave travelling from carotid to femoral artery. Results. Both groups were similar with regard to age, body mass index (BMI) and left ventricular ejection fraction. When diastolic functions were assessed, patients with POI had higher mean E/E’ratio (9.3 ± 1.9 vs. 7.6 ± 1.6, p < 0.001). POI patients have impaired MPI (0.9 ± 0.5 vs. 0.5 ± 0.2, p < 0.001) comparing to healthy controls but PWV measurements did not differ between two groups (5.7 ± 0.8 vs. 5.6 ± 0.6 m/s, p = 0.48). Conclusions. This study showed POI patients might have impaired global left ventricular functions comparing to age matched healthy controls and this might reflect the effects of premature lack of estrogen (E) on women’s cardiovascular (CV) system.

Badanie służące ocenie występowania choroby wieńcowej w młodym wieku

Introduction. An increasing number of younger patients are being hospitalized with acute coronary syndromes. Earlier risk assessment is essential to prevent or delay coronary artery disease (CAD). This study aimed to assess the rate, risk factor profile, presentation, management and prognosis in young patients with CAD and compared with the same age group without CAD. Material and methods. In this retrospective study, 4325 patients who had undergone coronary angiography from 2011 to 2014 were identified. A total of 627 patients were ≤ 45 years age; 412 of them had CAD, and 215 had normal coronary arteries (control group). Results. The mean age of the patients was 41.7 ± 4.1 years in the CAD group and 41.5 ± 4.5 years in the control group. The prevalences of dyslipidemia, smoking, family history of CAD, hypertension, diabetes, and overweight were higher in the CAD than in the control group. However, the obesity rate was not significantly different between the two groups. Patients with ACS often presented with ST elevation myocardial infarction (STEMI) (49.3%), and single-vessel involvement (55.3%) predominated. Percutaneous coronary intervention (PCI) was the main myocardial reperfusion therapy (68.4%). Conclusions. Among the young patients studied, CAD had a higher incidence in males. Smoking was the most important modifiable risk factor. Also, patients showed high prevalences of dyslipidemia, overweight, diabetes, and family history of CAD. This study re-emphasizes the relationship between traditional cardiovascular risks and CAD in young.

In-stent graft restenosis in the carotid artery. What is your opinion about this patient?

We previously reported the case of a 57-year-old male patient with a history of acute amaurosis fugax. Carotid angiography was performed as blood pressure differed between his left and right arms and there was a pan-systolic murmur on the left common carotid artery. Total occlusion of the proximal right brachiocephalic artery and a thrombus occluding 90–99% of the left internal carotid artery were detected by carotid angiogram. Cerebral perfusion was totally dependent on the left carotid artery system. Left internal carotid artery stenting was the chosen therapy but brain perfusion needed to be protected. The right common carotid artery occlusion meant a proximal blocking-based protection system could not be used as there was a high probability of embolism formation from the thrombus on the blocking lesion. We decided to place a graft-covered stent through the lesion first, and contain the plaque and thrombus between the stent and the lumen. Therefore, a graft-covered stent (5 × 13, Direct) was implanted with 12 atm pressure. Later, we opened the self-expanding stent (7 × 10 × 30, Cristallo) and dilated the stent using a post-dilatation balloon (5 × 20, Tarcomgrande) without the distal protection device system. A self-expanding stent and graft-covered stent were successfully implanted, and there were no complications. This case was published in a journal [1]. However, the patient presented transient ischemic attacks after three years. Digital subtraction angiography showed 99% in-stent restenosis in the overleap segment of both stents (Figure 1). The patient had a history of hypertension, coronary artery disease, hyperlipidemia and diabetes mellitus. The patient has been treated with aspirin (100 mg), clopidogrel (75 mg) and atorvastatin (40 mg), amlodipine (10 mg) and perindopril (10 mg/day) and subcutaneous insulin therapy for the last 3 years. On physical examination, his pulse was 80 bpm, and blood pressure was 135/85 mm Hg in the left arm and 80/60 mm Hg in the right arm. The laboratory tests revealed an low-density lipoproteins (LDL) level of 120 mg/dl (3.1 mmol/l) and a glycated hemoglobin level of 7%. What is your opinion about this patient?

Undeployed and uncrushed coronary stent in the proximal region of the normal left anterior descending artery revealed four years after intervention

Intracoronary undeployed stent embolization is a rare and devastating complication of percutaneous coronary intervention (PCI). This unexpected complication can lead to coronary thrombosis, myocardial infarction, cardiogenic shock and even death. Stent embolization or misplacement has been reported in 0.3% to 1.2% of PCIs in the literature [1, 2]. Several urgent retrieval and surgical management methods have been described, but short- and long-term outcomes remain unknown. We describe an unusual case of an undeployed coronary stent in a normal left anterior descending artery (LAD) revealed 4 years after coronary intervention. A 62-year-old man was admitted to our hospital with chest pain. He had a history of coronary artery disease with previous percutaneous coronary angioplasty and stenting in both the right coronary artery (RCA) and the left circumflex artery (LCX) 4 years ago. He had been treated with dual antiplatelet therapy for 1 month after coronary intervention, then clopidogrel therapy was withheld and acetylsalicylic acid therapy continued. After the first evaluation, left heart catheterization was planned. Coronary angiography showed an undeployed and uncrushed coronary stent in the proximal region of the normal LAD, and non-critical lesions in the RCA and LCX (Figure 1 A, ​,B).B). No further intervention was performed because distal coronary flow was normal and there was no critical stenosis. Myocardial perfusion scintigraphy (MPS) was planned to evaluate ischemia. Myocardial perfusion scintigraphy showed no ischemia (Figure 1 C). Several retrieval methods and crushing techniques have been described in the literature [1, 3]. Conservative treatment of the embolized stent after unsuccessful crushing has also been reported previously, but this is the first report of an undeployed and uncrushed embolized coronary stent in the proximal region of a normal LAD [4]. Figure 1 A, B – Arrows show the undeployed coronary stent in the proximal region of the LAD. Figure 1 C – Myocardial perfusion scintigraphy showed no ischemia

Konstriktif Perikardit- Kalp Yetersizliğinin nadir ancak önemli bir nedeni: Olgu Sunumu

Özet Olgu Sunumu / Case Report Yılmaz ve Ark. Kalp Yetersizliği nedeni olarak Konstriktif Perikardit Sakaryamj 2014;4(3):139-143 Giriş There are a few truly curable cardiac diseases. One of these is constrictive pericarditis (CP), a rare cardiac condition that usually manifests itself with nonspecific symptoms and signs spread out over many months or even years. Furthermore clinical signs and symptoms of right heart failure accompanied by existing risk factors for pericardial disease should raise suspicion for constrictive pericarditis. The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic other disease. A better appreciation of this disease is important, if one is to suspect its presence in a clinical scenario, which is an essential step that may lead to its diagnosis. Case Report A 34-year-old female presented with worsening dyspnea on exertion, fatigue and palpitation for two years. On examination, her blood pressure and pulse were 100/60 mmHg, 89 bpm respectively. She hadn’t jugular venous distention, ascites, an enlarged liver and pitting edema. On cardiac auscultation, there was a regular rhythm without any murmur and pericardial knock. She hadn’t history of tuberculosis, surgery, trauma, irradiation or other disease. Investigations looking for a possible cause of CP, such as viral markers, rheumatoid factor and antinuclear antibodies, were either negative or inconclusive. Electrocardiography showed sinus rhythm with non-specific diffuse T wave inversions. Chest X-ray did not show any sign of previous pulmonary tuberculosis, although the left lateral telecardiogram revealed thick intense calcification of the pericardium enclosing the heart (Fig. 1). Echocardiography showed mildly dilated left atrium with normal-sized left ventricle and particular thickening of the pericardium in the neighborhood of posterior left ventricular wall (Fig. 2a). A septal bounce (inspiratory septal shift to the left) was readily visualized in the apical four-chamber view. There was an increased respiratory variation of the early diastolic wave through the mitral valve (>25%) (Fig. 2b). The inferior vena cava was dilated (24.7 mm) and noncollapsing in the subcostal views (Fig. 2c). Tricuspid regurgitation was trivial with a pulmonary artery pressure of 35 mmHg. Tissue Doppler echocardiography showed an early diastolic mitral annular velocity E’of 14.7 cm/sec at the septal mitral annulus. Computed tomography of the thorax showed diffuse, incomplete calcification of the pericardium with a thickness ranging from 6 mm (Fig. 3a-b). Coronary angiography showed normal coronary arteries. However, pericardial calcification was seen near the apex on fluoroscopy. Simultaneous left and right heart catheterisations were performed and demonstrated elevation and equalisation of the diastolic pressures of all cardiac chambers to within 5 mmHg. The mean right atrial pressure was 18 mmHg with a prominent Y descent, right ventricular end diastolic pressure (RVEDP) 18 mmHg, left ventricular end diastolic pressure (LVEDP) 17 mmHg and pulmonarycapillary wedge pressure 20 mmHg. The ventricular tracing showed a dip-and-plateau pattern (“square root sign”). The diagnosis was calcific CP. The council of cardiology and cardiovascular surgery decided to close clinical follow-up of patients, because of there is no serious symptoms of heart failure yet. Figure 1: Lateral chest x-ray demonstrates pericardial calcification Figure 2a: 2-D Echocardiography showed particular thickening of the pericardium on the posterior of left ventricle, 2b: Pulsed-wave Doppler at the mitral valve shows increased respiratory variation and decreased deceleration time of the E 140