Suat Görmel

Evaluation of the coronary flow by the coronary clearance time in patients with cardiac syndrome X

Objective The vessels involved in the microcirculation are too small to be visualized by conventional angiography and no tools are currently available that can directly evaluate the coronary microcirculation. This study evaluated the coronary clearance frame count (CCFC) in patients with cardiac syndrome X (CSX). Methods The retrospective study enrolled patients with angina, who had a positive nuclear imaging test and normal coronary angiography; and a control group consisting of patients who underwent an angiogram to exclude coronary artery disease. Thrombosis in myocardial infarction frame count (TFC) and CCFC for each coronary artery (left anterior descending coronary artery [LAD], circumflex coronary artery [CFX] and right coronary artery [RCA]) were calculated offline. Results A total of 71 patients with CSX and 61 control patients were enrolled in the study. No significant differences were found between the two groups regarding the baseline demographic and clinical variables. The TFC of LAD, CFX and RCA were similar between the two groups. The mean CCFC-LAD, CCFC-CFX and CCFC-RCA were significantly longer in the CSX group compared with the control group. Conclusion CCFC is a simple, quantitative and highly reproducible method that might be used as a marker of coronary microvascular dysfunction.

Relationship between Pulmonary Artery Stiffness and Functional Capacity in Patients with Heart Failure with Reduced Ejection Fraction

Background and Objectives Functional capacity varies significantly among patients with heart failure with reduced ejection fraction (HFrEF), and it remains unclear why functional capacity is severely compromised in some patients with HFrEF while it is preserved in others. In this study, we aimed to evaluate the role of pulmonary artery stiffness (PAS) in the functional status of patients with HFrEF. Methods A total of 46 heart failure (HF) patients without overt pulmonary hypertension or right HF and 52 controls were enrolled in the study. PAS was assessed on parasternal short-axis view using pulsed-wave Doppler recording of pulmonary flow one centimeter distal to the pulmonic valve annulus at a speed of 100 mm/sec. PAS was calculated according to the following formula: the ratio of maximum flow velocity shift of pulmonary flow to pulmonary acceleration time. Results PAS was significantly increased in the HFrEF group compared to the control group (10.53±2.40 vs. 7.41±1.32, p<0.001). In sub-group analysis of patients with HFrEF, PAS was significantly associated with the functional class of the patients. HFrEF patients with poor New York Heart Association (NYHA) functional capacity had higher PAS compared those with good functional capacity. In multivariate regression analysis, NYHA class was independently correlated with PAS. Conclusion PAS is associated with functional status and should be taken into consideration as an underlying pathophysiological mechanism of dyspnea in patients with HFrEF.

Relationship between the Extent of Coronary Artery Disease and In-stent Restenosis in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

OBJECTIVE The pathophysiological mechanism of in-stent restenosis (ISR) is different from atherosclerosis of native coronary arteries. The aim of this study was to evaluate the relationship between ISR and the extent of coronary artery disease (CAD), and to identify other risk factors associated with ISR in ST-segment elevation myocardial infarction (STEMI) patients. METHODS A total of 372 consecutive patients presenting with first acute STEMI who were successfully treated with primary percutaneous coronary intervention within 12 hours from the onset of symptoms and who had an angiographic follow-up at 3 months were included in the study. The extent of CAD was calculated using the Gensini score. RESULTS The incidence of ISR observed in our group of patients was 23.4% (n=87). The mean Gensini score was significantly higher in patients with ISR when compared with group without restenosis (69 [range: 51-90] vs 42 [range: 32-61]; p<0.001). The presence of diabetes mellitus, left ventricular ejection fraction (LVEF), and low-density lipoprotein cholesterol (LDL-C) level differed significantly between the 2 groups (p<0.05 for all). Stent diameter and stent length were found to be significantly different between the ISR group and the no-restenosis group (p<0.05 for both). In multivariate logistic regression analysis, the Gensini score, stent diameter, stent length, LVEF, and LDLC were independently associated with ISR. CONCLUSION Despite the differences in the underlying pathophysiological mechanism of ISR and native coronary atherosclerosis, patients with a greater extent of CAD should be considered candidates for future stent restenosis.

Torsade de Pointes Triggered by Early Ventricular Escape Beats in a Patient with Complete Atrioventricular Block.

Torsade de pointes is an uncommon and malignant form of polymorphic ventricular tachycardia and associated with a prolonged QT interval, which may be congenital or acquired. Complete atrioventricular block may cause QT interval prolongation and torsade de pointes. In this paper, we present a case with complete atrioventricular block complicated with frequent episodes of torsade de pointes triggered by early premature ventricular contractions despite normal QT intervals.

The relationship between blood pressure variability and Pooled Cohort Risk Assessment Equations 10-year cardiovascular risk score.

BackgroundRecent attention has focused on the clinical significance of blood pressure variability (BPV) in explaining the adverse cardiovascular consequences of hypertension. We therefore analyze the impact of 24 h BPV on the development of future cardiovascular disease determined by The Pooled Cohort Risk Assessment Equations 10-year risk calculator. Materials and methodsWe analyzed 250 adult patients, ages 40–80 years old. The ambulatory blood pressure monitoring was recorded automatically. We defined the mean blood pressure values, SD, and coefficient of variation (CV) of blood pressure on the basis of the recorded 24 h ambulatory blood pressure monitoring values as an indicator for BPV.Patients were divided into two groups according to their Pooled Cohort Risk Assessment Equations 10-year risk profile (<7.5 and ≥7.5%). ResultsBesides the mean systolic blood pressure (SBP), parameters showing the BPV such as SD and CV of mean blood pressures were also significantly higher in patients with an elevated 10-year risk score compared with others. Only CV of SBP and pulse pressure showed a clear association with the 10-year risk in multivariate logistic regression analysis. The results suggested that each 1% increase in CV of SBP could lead to a 1.258-fold increase in The Pooled Cohort Risk Assessment Equations 10-year risk score. ConclusionIn the present study, we found that independent of baseline SBP, increased CV of SBP within 24 h was associated with increased cardiovascular risk, as assessed by The Pooled Cohort Risk Assessment Equations 10-year risk calculator.