Sabri Demircan

Efficiency of atorvastatin in the protection of anthracycline-induced cardiomyopathy.

To the Editor: Antineoplastic agents of the anthracycline (ANT) group are commonly and effectively used in various forms of malignancies. Anthracyclines might lead to irreversible cardiomyopathy (CMP), despite their beneficial effects. A number of mechanisms, such as elevation in free superoxide

The Importance of Gamma‐Glutamyltransferase Activity in Patients with Coronary Artery Disease

In this study, we sought to investigate the relation of gamma‐glutamyltransferase (GGT) levels with the significance of coronary artery disease (CAD), clinical presentation, left ventricular (LV) function, and inflammatory activity.

Intracoronary guidewire emboli: a unique complication and retrieval of the wire.

The breakdown of the guidewire during percutaneous coronary intervention (PCI) and the retention of the broken part inside the coronary or systemic vascular system is a rare complication. With the use of a flexible guidewire, the incidence of these complications has markedly decreased. In this case report, we report the withdrawal of a broken guidewire from the distal coronary during PCI.

The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention

PURPOSE It has been known that inflammatory mechanisms play an important role in the coronary artery disease. Our aim in this study was to investigate the relationship between the neutrophil/lymphocyte (N/L) ratio and coronary flow velocity after primary percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS Two hundred and ten patients who had undergone primary PCI were included. The coronary flow velocities were evaluated using the recorded PCI procedures by Thrombolysis in Myocardial Infarction (TIMI) flow grades and corrected TIMI frame counts (cTFC) values. A value of >40 for the final cTFC was accepted as an index of insufficient coronary blood flow. The white blood cell subtypes and counts were determined in the blood samples obtained at the clinics. RESULTS In 165 (78%) of the investigated patients, reperfusion was found to be sufficient (Group I) while in 45 (22%) of them (Group II) insufficient reperfusion was observed (Group II). In-hospital mortality was 7.2% (n=12) in Group I, whereas it was 17.7% (n=8) in Group II (P=0.033). Similarly, one-year mortality was higher in Group II (26.6%, n=12) than in Group I (13.3%, n=22) (P=0.031). N/L ratio was determined to be higher in Group I than in Group II (8.3±6.1 vs. 6.2±5.0; P=0.034). Also, N/L ratio was found as an independent predictor of severe no-reflow development (TIMI 0-1) and of one-year mortality (P=0.01 and P=0.047, respectively). CONCLUSIONS N/L ratio has been found to be an independent indicator for no-reflow development in patients who have undergone PCI for acute STEMI. This simple and low-cost parameter can provide useful information for the relevant risk evaluation in these patients.

Longitudinal Diastolic Myocardial Functions Are Affected by Chronic Smoking in Young Healthy People: A Study of Color Tissue Doppler Imaging

Aims: Many cardiac and hemodynamic alterations occur after acute consumption of cigarettes. The aim of this study is to evaluate the effect of chronic smoking on longitudinal myocardial functions of left ventricle in young, healthy people by using color tissue Doppler imaging modalities. Methods and Results: Ninety‐nine healthy participants were studied. There were 65 smokers and 34 nonsmokers. All subjects were between 20 and 35 years old. Sample volumes were placed on the mid left ventricle in the inner half of the myocardium at the septum, lateral, inferior, and anterior walls. The peak systolic strain (S‐S), peak systolic strain rate (S‐SR), peak early diastolic SR (E‐SR), peak late diastolic SR (A‐SR), peak systolic tissue velocity (S‐TV), peak early diastolic TV (E‐TV), and peak late diastolic TV (A‐TV) values were measured. For the systolic parameters S‐S, S‐SR, and S‐TV values were not different between the groups. For the diastolic parameters smokers had lower E‐SR and E‐TV values than nonsmokers (P = 0.03 for both). Although there was a trend toward higher A‐SR and A‐TV values in the smokers, they were not reaching the statistical significance. Conclusion: Chronic smoking in young, healthy people causes significant alterations in the longitudinal diastolic myocardial function parameters as assessed by color tissue Doppler imaging.

The Role of Adrenergic Activity in Slow Coronary Flow and Its Relationship to TIMI Frame Count

The aim of this study was to investigate the role of adrenergic activity in patients with slow coronary flow (SCF) and its relationship to TIMI frame count on the pathogenesis of SCF. Plasma noradrenalin and adrenalin concentrations at rest were compared in 51 patients diagnosed with SCF through coronary angiography and TIMI frame count; and 44 healthy controls with normal coronary flow (NCF). Furthermore, the relationship between TIMI frame count and noradrenalin and adrenalin levels was investigated. Plasma noradrenalin (127.9 ±9.2 and 79.3 ± 7.3 ng/mL, p < 0.0001) and adrenalin levels (63.9 ± 2.6 and 44.7 ± 2.8 ng/mL, p < 0.0001) were higher in patients with SCF when compared to patients with NCF. Noradrenalin and adrenalin levels were effected with SCF-dominant vessels with respect to TIMI frame count (p = 0.012 and p < 0.0001). Patients with SCF in 1, 2, or 3 vessels had different noradrenalin and adrenalin levels (p <0.003 and p < 0.0001). Patients with TIMI frame count above the 75th percentile had significantly higher noradrenalin and adrenalin levels when compared with those between the 25th—50th percentiles and below (p < 0.001 and p = 0.011, respectively). Correlation analysis established that both adrenalin and noradrenalin levels were correlated with TIMI frame counts of left anterior descending (LAD) and circumflex (Cx) arteries. Exercise testing revealed ischemia in 6 patients. Their TIMI frame counts were above the 75th percentile, and they had higher noradrenalin and adrenalin levels when compared with those without ischemia (p = 0.029, p = 0.045). Higher noradrenalin and adrenalin levels and correlation between TIMI frame count and ischemia in patients with SCF suggest that increased adrenergic activity may be the manifestation of slow coronary flow.

The effect of glucose-insulin-potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention.

ObjectivesIn this study, we sought to examine the effect of glucose–insulin–potassium (GIK) treatment on oxidative stress in patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary interventions (PCIs). MethodsPatients with ACSs who had been electively treated with a stent implantation into the culprit vessel were included in this study. Patients were divided into two groups and were randomly administered either the GIK treatment (GIK group; n=28) or isotonic NaCl (control group; n=19) infusion during PCI. Blood samples from the coronary artery ostium (CO) were collected through the femoral artery and from the coronary sinus (CS) through the femoral vein, before and immediately after PCI. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured. ResultsA total of 47 patients were included in the study. SOD, CAT, and GSH-Px activities, whether in the CO or the CS, were similar in both the GIK and control groups before the intervention (P>0.05). In the control group, SOD (in both the CO and the CS), CAT (in the CS), and GSH-Px (in the CS) activities were higher compared with baseline values (P<0.05). Such increases were, however, not seen in the GIK group (P>0.05). Although the CS–CO activity differences (venous–arterial) of SOD, CAT, and GSH-Px, which are parameters of myocardial reactive antioxidant enzyme production, were increased in the control group, there was no increase in the GIK group. ConclusionsIn patients with ACSs, reactive local enzyme activity increases for the scavenging to myocardial-free radicals during PCI. Administration of a solution of GIK as a metabolic support agent might prevent oxidative stress in the myocardial level, in these patients.

Evaluation of the Relationship Between Arterial Blood Pressure, Aortic Stiffness and Serum Endothelin-1 Levels in Patients with Essential Hypertension

This study has attempted to evaluate the relationship between aortic stiffness, blood pressure (BP) and serum endothelin-1 (ET-1) levels in patients with essential HT. Totally 152 subjects, consisting of 103 patients diagnosed with HT at least 1 year previously and 49 healthy individuals, were enrolled in this study. They were subdivided, on the basis of BP measurements made at home, into three groups as the hypertensives with dysregulated BP (n = 56), the hypertensives with regulated BP (n = 47) and the normotensive controls (n = 49). Statistically significant differences were observed between the three groups with respect to aortic elasticity parameters (p < 0.01 for aortic strain, aortic distensibility and aortic stiffness). Serum ET-1 levels in the three groups were similar (p = 0.101), but a significant correlation was observed between the ET-1 values and the aortic elasticity parameters (p = 0.004). Alteration of the aortic elasticity parameters in patients with HT not only correlates with the serum ET-1 levels indicating endothelial dysfunction but also gives direct clues about status of BP regulation.

The relation between endothelin-1 levels and myocardial injury in chronic ischemic heart failure.

We evaluated whether there was any relation between myocardial injury and endothelin-1 (ET-1) levels, which has been suggested as a contributor to the progression of ischemic heart failure. One hundred and twenty-one patients with chronic ischemic heart failure and 37 healthy individuals were included in the study. Cardiac troponin-I (cTn-I) and ET-1 levels of all subjects were measured on admission. Echocardiographic evaluations were also performed. The positivity of cTn-I increased significantly as the severity changed from New York Heart Association (NHYA) Class I to IV (P < 0.01). This was also true for quantitative cTn-I levels (P < 0.05). The ET-1 levels of patients were higher than controls on admission (P < 0.001). The ET-1 levels increased significantly upon the progression from NHYA Class I to IV (P < 0.001). Moreover, patients with cTn-I positivity had higher ET-1 levels (P < 0.05) and a lower ejection fraction (P < 0.001). A negative correlation was found between ejection fraction and the ET-1 levels (r = −0.312, P = 0.019). In patients with cTn-I positivity, the cTn-I levels showed a positive correlation with the ET-1 levels (r = 0.328, P = 0.014) and a negative correlation with ejection fraction (r = −0.671, P < 0.001). In chronic ischemic heart failure, an increase in ET-1 may exert an influence on the progression of cardiac failure by leading to myocardial injury which may be demonstrated by higher cTn-I levels.

Prevalence and Characteristics of Coronary-Cameral Communications in Adult Patients: Coronary Angiographic Analysis of 16,573 Patients

Objective: To analyze the coronary angiograms of patients with symptomatic heart disease in order to determine the frequency and characteristics of coronary-cameral communications (CCCs) in a single center. Subjects and Methods: The coronary angiograms of 16,573 patients with symptomatic heart disease performed from November 2001 to January 2011 were analyzed. The diagnosis of coronary fistula and coronary-cameral microcommunications (CCMCs) was made according to previously defined criteria. Results: Of the 16,573 patients, 15 (0.09%; 8 males and 7 females, mean age 63 ± 12 years) had CCCs, while coronary fistulas were identified in 2 (0.01%). In the first patient, the coronary fistula arose from the branches of the left anterior descending (LAD) artery and the right coronary artery (RCA) and drained into the right ventricle. In the second patient, the fistula originated from branches of the LAD artery, the circumflex (Cx) artery and the RCA and drained into the left ventricle. In 7 patients, the CCMCs originated from the LAD artery. In 3 patients, the Cx artery was the origin. The CCMCs originated from the RCA in 2 patients. In 1 patient the CCMC took its origin from the RCA and the Cx artery, while in 2 patients the CCMCs were associated with intracardiac masses in the left atrium and the right atrium, respectively. Conclusion: The prevalence of CCCs in adult patients was low and that of large coronary fistulas was even lower; coronary fistulas are probably very rare in adult patients because the majority of them are detected and treated during childhood.