Seref Kul

A New Parameter Predicting Chronic Total Occlusion of Coronary Arteries Platelet Distribution Width

Platelet distribution width (PDW) measures the variability in platelet size and is a marker of platelet activation. We investigated whether PDW is associated with the extent of coronary artery disease (CAD) and coronary total occlusions (CTOs). We studied 162 patients: 108 had a coronary lesion with a diameter stenosis of ≥50%, the CAD(+) group, and 54 patients had normal coronary anatomy, the CAD(−) group. The CAD(+) group was subdivided into CAD(+) CTO(+) and CAD(+) CTO(−) groups. Among patients with CAD, the CTO(+) group had a significantly greater PDW (%) than the CTO(−) group (16.9 ± 2.8, 15.4 ± 3.0, and 15.4 ± 1.9, respectively; P = .008). In a receiver–operating characteristic analysis, a PDW cut point of 15.7% was identified in patients with CTO(+) (area under curve = 0.64, 95% confidence interval 0.54-0.75). A PDW value of more than 15.7% demonstrated a sensitivity of 64% and a specificity of 66%. The PDW is a simple platelet index that may predict the presence of CTO.

Electrocardiographic P-wave characteristics in patients with psoriasis vulgaris.

Abstract Purpose. Psoriasis vulgaris is one of the most common skin disorders. Patients with psoriasis carry an excessive risk of atrial fibrillation (AF). The differences between the maximum (Pmax) and the minimum (Pmin) P-wave duration on ECG are defined as P-wave dispersion (PWD). Prolongation of PWD is an independent risk factor for the development of AF. The aim of this the study was to investigate P-wave duration and PWD in patients with psoriasis. Methods. Sixty-one adult patients with psoriasis vulgaris (group 1) and 58 age and sex-matched healthy individuals (group 2) were included in this study. ECG recordings were obtained, and the P-wave variables were calculated. Results were reported as mean ± standard deviation and percentages. Continuous variables were analysed using Students t test. A value of P < 0.05 was considered statistically significant. Results. Pmax and PWD were significantly higher in group 1 than in group 2 (108.8 ± 21.3 ms versus 93.3 ± 13.0 ms, P < 0.001; 67.4 ± 22.9 ms versus 45.0 ± 19.6 ms, P < 0.001, respectively). Also, Pmin was significantly lower in group 1 (41.3 ± 12.3 ms versus 48.3 ± 14.3 ms, P = 0.04). The psoriasis disease activity score and hsCRP correlated with PWD (P < 0.01). Conclusions. Atrial conduction of sinus impulses was impaired in patients with psoriasis vulgaris. It was more prominent in patients with severe disease. Physicians caring for patients with psoriasis vulgaris should screen them for AF development.

High SYNTAX score predicts worse in-hospital clinical outcomes in patients undergoing primary angioplasty for acute myocardial infarction.

ObjectiveA high SYNTAX score (SXscore) is a predictor of adverse outcomes for stable and unstable coronary syndromes. We aimed to examine whether a high SXscore will determine in-hospital clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. MethodsA total of 646 (mean age 56.1±12.5; 516 males, 130 females) patients with STEMI undergoing a primary percutaneous coronary intervention were evaluated prospectively. The study population was divided into tertiles based on the SXscore values. A high SXscore (n=196) was defined as a value in the third tertile (>21.75), and a low SXscore (n=450) was defined as a value in the lower two tertiles (⩽21.75). Patients were followed up for in-hospital clinical outcomes. ResultsIn-hospital cardiovascular mortality occurred more in the high SXscore group than in the low SXscore group (10.7 and 2.4%, respectively, P<0.001). In a receiver-operating characteristic curve analysis, an SXscore value of 21.75 was identified as an effective cut point in STEMI for in-hospital cardiovascular mortality (area under curve=0.75, 95% confidence interval: 0.66–0.83, P<0.001). An SXscore value of more than 21.75 yielded a sensitivity of 66% and a specificity of 71.5%. A significant association was noted between a high SXscore level and the adjusted risk of in-hospital cardiovascular mortality (odds ratio: 3.92, 95% confidence interval: 1.1–13.9, P=0.03). ConclusionOur findings showed that patients with a high SXscore undergoing primary angioplasty for STEMI have a poor in-hospital survival, and that a high SXscore represents an independent risk factor for in-hospital cardiovascular mortality.

Endovascular therapy of acute ischaemic stroke by interventional cardiologists: single-centre experience from Turkey.

AIMS We report our single-centre experience with the Solitaire AB self-expanding retrievable stent system in patients with acute ischaemic stroke. METHODS AND RESULTS Demographic, clinical, and angiographic findings of thirty-eight consecutive patients with acute ischaemic stroke who underwent mechanical thrombectomy were evaluated retrospectively. The mean initial National Institutes of Health Stroke Scale (NIHSS) score was 17.8±4.6. Nearly half of the patients had a middle cerebral artery (MCA) occlusion (45%). Both internal carotid artery and MCA occlusions were detected in five patients. Successful revascularisation (Thrombolysis in Cerebral Infarction [TICI] 2b and 3) was achieved in 34 of 38 (89%) patients; a TICI 3 state was observed in 24 (63%) patients. Almost three quarters of the patients (74.3%) improved by >5 points on the NIHSS at discharge, and 57.9% showed a modified Rankin Scale (mRS) score of ≤2 at 90 days. CONCLUSIONS This single-centre experience with mechanical thrombectomy devices demonstrated that the procedure could be performed safely with high success rates by experienced interventional cardiologists in suitably equipped cathlabs.

The relationship between γ-glutamyl transferase levels and the clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

ObjectivesSerum &ggr;-glutamyl transferase (GGT) activity has been shown to be related to the development of atherosclerosis and cardiovascular events. The aim of this study was to evaluate the prognostic value of GGT in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (PCI). Patients and methodsA total of 683 consecutive patients with STEMI who underwent primary PCI were evaluated. The study population was divided into tertiles on the basis of admission GGT values. A high GGT (n=221) was defined as a value in the upper third tertile (GGT>37) and a low GGT (n=462) was defined as any value in the lower two tertiles (GGT⩽37). The mean follow-up time was 29 months. ResultsThe in-hospital mortality rate was significantly higher in patients in the high GGT group (7.2 vs. 1.7%, P<0.001), as was the rate of adverse outcomes in patients with high GGT levels. In multivariate analyses, a significant association was found between high GGT levels and adjusted risk of in-hospital cardiovascular mortality (odds ratio=8.6, 95% confidence interval: 2.3–32.4, P=0.001). In a receiver operating characteristic curve analysis, a GGT value greater than 37 was identified as an effective cutoff point in STEMI for in-hospital cardiovascular mortality (area under curve=0.71, 95% confidence interval: 0.59–0.82, P<0.001). There were no differences in the long-term adverse outcome rates between the two groups. ConclusionGGT is a readily available clinical laboratory value associated with in-hospital adverse outcomes in patients with STEMI who undergo primary PCI. However, there was no association with long-term mortality.

Prognostic impact of red blood cell transfusion in patients undergoing primary angioplasty for ST elevation myocardial infarction.

ObjectivesWe aimed to examine in-hospital and long-term outcomes of red blood cell (RBC) transfusions in patients undergoing a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). MethodsOverall, 2537 consecutive STEMI patients (mean age 56.2±11.7 years, 2111 men, 426 women) undergoing primary angioplasty were enrolled retrospectively into the present study. Patients were categorized according to whether they received RBC transfusions during hospitalization. Clinical characteristics, and in-hospital and long-term outcomes of the primary PCI were analyzed. ResultsOf the consecutive 2537 patients, 88 (3.4%) received RBC transfusions during the index hospitalization. The transfused patients were older than nontransfused patients (mean age 63.6±12.1 vs. 56.2±11.8, P<0.001). Compared with nontransfused patients, female sex and hypertension were more prevalent in transfused patients (45.4 vs. 15.8%, P<0.001; 52.3 vs. 40.7%, P=0.04, respectively). Baseline values of hematocrit and hemoglobin were lower in patients receiving transfusion (33±6.2 vs. 40.2±4.7%, P<0.001; 11.1±2.3 vs. 13.7±1.6 mg/dl, P<0.001, respectively). The transfused patients had significantly higher in-hospital and long-term mortality (for in-hospital mortality: 10.2 vs. 2.7%, P<0.001; for long-term mortality: 14.1 vs. 5.1%, P=0.001). By multivariate Cox regression analysis, in all 2537 patients, RBC transfusion was found to be a powerful independent predictor of in-hospital cardiovascular mortality (odds ratio 8.31, P<0.001). ConclusionThese results show that RBC transfusion is associated with increased in-hospital and long-term mortality in patients with STEMI undergoing a primary PCI.

Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

Objective Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events. We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients (> 65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction. Methods We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ± 5.4). Patients were divided into two groups according to admission blood glucose levels. Group 1: low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose > 168 mg/dL. Results In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P < 0.001). Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI < 3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P < 0.001). Conclusions Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality.

Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.

Is Postdilatation with a Noncompliant Balloon Necessary after Coronary Stent Deployment during Primary Angioplasty

BACKGROUND Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention (PCI) is performed usually in clinical practice in order to optimize stent expansion. However, current knowledge about its use in patients undergoing primary PCI is controversial. This study aims to evaluate the angiographical and clinical results of PD in patients who underwent primary PCI with drug eluting stents (DESs). METHODS A total of 405 consecutive patients (mean age 56.9 ± 12.3 years; 302 male) with ST elevation myocardial infarction were evaluated retrospectively. Patients received DES with or without predilatation according to physicians discretion. Eligible patients were divided into 2 groups based on PD procedure. The clinical end-points were death, target vessel revascularization (TVR) and stent thrombosis at 6 months after PCI. The angiographic end-points were postprocedural correct Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC), final TIMI flow, and myocardial blush grade (MBG). RESULTS PD was performed in 214 patients (52.8%). Angiographical parameters such as TIMI flow, cTFC, and MBG did not differ after PD (P>0.05). During 6-month follow-up, TVR and stent thrombosis rates were lower in the PD group (6 vs. 16, P=0.03; and 3 vs. 10, P=0.04, respectively). PD and diabetes were detected as independent predictors of MACE (β=0.52, P=0.01, and β=-0.47, P=0.02; respectively). CONCLUSION Our study revealed that PD does not yield adverse effects on final angiographic parameters when performed during primary PCI. Besides PD seems to decrease probability of stent thrombosis and TVR.

Subclinical left ventricular dysfunction in women with polycystic ovary syndrome: an observational study

OBJECTIVE Cardiac involvement has been increasingly recognized in patients with polycystic ovary syndrome (PCOS). Identification of the earliest asymptomatic impairment of left ventricular (LV) performance may be important in preventing progression to overt heart failure. Our aim was to investigate LV function with different echocardiographic techniques in patients with PCOS. METHODS Thirty patients with PCOS and 30 age and body mass index matched healthy subjects were enrolled to this cross-sectional observational study. All subjects underwent echocardiography for assessment of resting LV function as well as two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (3D-Echo). Global longitudinal strain (GLS) was calculated from 3 standard apical views using 2D-STE. Student t-test, chi-square test, Pearsons, and Spearmans correlation analysis were used for statistical analysis. RESULTS The early mitral inflow deceleration time (DT), isovolumetric relaxation time (IVRT) and E/Em ratio were increased in the PCOS group (p<0.05 for all). Waist-to-hip ratio, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and low-density lipoprotein (LDL) levels were higher in PCOS group (p<0.05 for all). Significant correlation was observed between DT, IVRT and insulin value, HOMA-IR (p<0.05 for all). On 3D-Echo evaluation, none of the patients in both groups had LV systolic dysfunction with comparable LV ejection fraction and LV volumes. 2D-STE showed that GLS was significantly reduced in the PCOS group compared to control group (-16.78 ± 0.56% vs. -18.36 ± 1.04%, p<0.001). The GLS was found to be negatively correlated with waist-to-hip ratio and LDL values (p<0.05 for all). CONCLUSION These results indicate that PCOS may be related to impaired LV systolic function detected by 2D-STE. In addition, PCOS may lead to diastolic dysfunction. Reduced GLS might be an early indicator of cardiac involvement in this patient population.