Suleyman Ercan

Role of inferior vena cava and right ventricular diameter in assessment of volume status: a comparative study: ultrasound and hypovolemia.

OBJECTIVE Ultrasonography has been suggested as a useful noninvasive tool for the detection and follow-up for hypovolemia. Two possible sonographic markers as a surrogate for hypovolemia are the diameters of the inferior vena cava (dIVC) and the right ventricle (dRV). The goal of this study was to evaluate IVC and RV diameters and diameter changes in patients treated for hypovolemia and compare these findings with healthy volunteers. METHODS Fifty healthy volunteers and 50 consecutive hypovolemic patients were enrolled in the study. The dIVC, both during inspiration (IVCi) and expiration (IVCe), was measured in hypovolemic patients both before and after fluid resuscitation, and they were also measured in healthy volunteers during the time they participated in the study. The dIVC, in hypovolemic patients both before and after fluid resuscitation, was measured ultrasonographically by M-mode in the subxiphoid area. The dRV was measured ultrasonographically by B-mode in the third and fourth intercostals spaces. RESULTS The average diameters of the IVCe, IVCi, and dRV in hypovolemic patients upon arrival were significantly lower compared with healthy volunteers (P = .001). After fluid resuscitation, there was a significant increase in the mean diameters of the IVCe, IVCi, and RV in hypovolemic patients (P = .001). CONCLUSIONS The results indicate that the dIVC and dRV are consistently low in hypovolemic subjects when compared with euvolemic subjects. Bedside serial measurements of dIVC and dRV could be a useful noninvasive tool for the detection and follow-up of patients with hypovolemia and evaluation of the response to the treatment.

Relationship between mean platelet volume and atrial thrombus in patients with atrial fibrillation.

Platelets and clotting cascade play a major role in development of atrial thrombus in patients with atrial fibrillation. The mean platelet volume (MPV) reflects platelet size and is considered a marker and determinant of platelet function because larger platelets are hemostatically more reactive than platelets of normal size, increasing the propensity to thrombosis. We have investigated the relationship between MPV and left atrial thrombus in patients with persistent atrial fibrillation. A total of 205 consecutive patients (men: 67.3%, women: 32.7%; mean age: 62.3 ± 12.8) who had persistent atrial fibrillation, undergone transesophageal and transthoracic echocardiography. Study individuals were divided into two groups. Group 1 (n: 96, 46.8%): atrial fibrillation complicated with atrial thrombus and group 2 (n: 109, 53.2%): atrial fibrillation free of thrombus, which was identified by means of transesophageal echocardiogram. The MPV, platelet distribution weight, and platelet count were measured. There was no difference in terms of MPV, platelet distribution weight, and platelet count in two groups. MPV was not correlated with thrombus and spontaneous echo contrast. Left atrial thrombus was included in multivariate logistic regression analysis and only low ejection fraction was a predictor of left atrial thrombus (P = 0.04). This is first report showing that MPV is not related with left atrial thrombus in patients with atrial fibrillation. According to our result, MPV cannot be considered as an index of left atrial thrombus in patients with atrial fibrillation.

Circadian Blood Pressure Variation in Normotensive Patients With Panic Disorder

Nondipper pattern of blood pressure (BP) is associated with cardiovascular risk. In this study, we compared dipper versus nondipper patterns between normotensive patients with panic disorder (PD) and a control group. A total of 25 normotensive patients with PD and 25 controls were enrolled. Twenty-four-hour ambulatory BP monitoring was performed in all patients. At least 10% of sleep-related nocturnal decrease in systolic and diastolic BP was accepted as dipper status, while decreases <10% were defined as a nondipper. Patients with PD had significantly higher incidence of nondipper BP pattern than controls. The reduction of nighttime BP in both systolic and diastolic and mean BP was significantly lower in patients with PD than in the control group (7.6% ± 4.3% vs 13% ± 3.9%, P < .001; 11% ± 7% vs 15% ± 5%, P = .004; 9% ± 5% vs 14% ± 4%, P = .002, respectively). Panic disorder is associated with nondipper BP pattern, causing impaired circadian BP in normotensive settings.

Circadian Variation of Blood Pressure Is Impaired in Normotensive Pregnant Women with Gestational Diabetes Mellitus

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP – sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m2 vs. 90.67 ± 15 g/m2, P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

Prognostic Role of Incidental Pleural Effusion Diagnosed During Echocardiographic Evaluation

The purpose of this study was to determine the long‐term prognostic implications of incidental pleural effusion (PE) detected during echocardiographic examination and its relationship with concomitant diseases.

Complete thrombus resolution with tirofiban in obstructive mechanical prosthetic mitral valve thrombosis.

Mechanical prosthetic valve thrombosis is a rare but life threatening complication after valve replacement. Although the traditional treatment of prosthetic valve thrombosis is surgery, recently thrombolytic therapy has been accepted as an alternative treatment. We describe for the first time prosthetic valve obstructive thrombus that was resolved by administering tirofiban (glycoprotein IIb/IIIa receptor antagonist) in a patient using warfarin with an international normalized ratio of 3.4. In our view, although this issue need to be clarified in further studies, tirofiban seems to be an alternative therapy especially in patients who have high risk of bleeding or surgical complication.

Anxiety Score as a Risk Factor for Radial Artery Vasospasm During Radial Interventions A Pilot Study

We determined the role of anxiety level on radial artery spasm during transradial coronary angiography. Eighty-one patients who had an indication for coronary angiography were enrolled. Radial artery vasospasm was determined by addressing 5 signs: persistent forearm pain, pain response to catheter manipulation, pain response to sheath withdrawal, difficult catheter manipulation after being “trapped” by the radial artery, and considerable resistance on withdrawal of sheath. Radial spasm defined as at least 2 of the 5 signs. The Hamilton Anxiety scale questionnaire was used to determine the level of anxiety. Vasospasm was observed in 19.1% of the patients. Anxiety score was significantly higher in women (11.1 ± 7.2 vs 17.6 ± 7.3; P < .001). Vasospasm was significantly correlated with female sex (P < .001, r = .43) and anxiety score (P = .007, r = .29). Female sex was associated with higher anxiety scores (P < .001, r = .43). In conclusion, higher anxiety scores and female sex are important risk factors for radial artery vasospasm.

Giant Pulmonary Artery Aneurysm: 12 Years of Follow-up. Case Report and Review of the Literature

Pulmonary artery aneurysm (PAA) is defined as pulmonary artery diameter of greater than 4 cm. PAA is not frequently encountered in clinical practice. There is a rare report in giant low-pressure PAA in terms of long-term follow-up. Herein, we sought to report a case of idiopathic PAA that was followed for 12 years in view of its learning points and to review the current literature for PAA. Herein we observed learning points according to long-term follow-up of PAA case as follows. PAA progressed dramatically after reaching a diameter greater than 6 cm and resulted in 7.87 cm in 2 years according to our case observation. Pericardial effusion may develop after a dramatic increase of PAA diameter. The reason for pericardial effusion is not always dissection or rupture; the presence of pericardial effusion possibly stemmed from the impairment of lymphatic drainage because of pressure effect on lymphatic circulation. Progressive increase of dilatation may lead to cough, as in our case.

Coronary artery tortuosity: comparison with retinal arteries and carotid intima-media thickness

BACKGROUND AND AIM We conducted a prospective study to investigate the possible relationship between the tortuosity of coronary arteries (TCA) and carotid intima-media thickness (CIMT), and also compare TCA to retinal artery tortuosity. METHODS One hundred and five participants with nonsignificant coronary plaque or normal coronary angiogram were included. To determine subclinical atherosclerosis, maximum CIMT was measured. Retinal tortuosity was evaluated ophthalmically. RESULTS Among all demographic variables and risk factors, only female gender and height were significantly associated with TCA (p = 0.001, p = 0.01, respectively). Retinal artery tortuosity and retinal artery atherosclerosis were more common inpatients with TCA compared to patients without TCA (p < 0.001, R = 0.6; p = 0.002, R = 0.4, respectively). CIMT was greater in participants with TCA than patients without TCA (p = 0.001), and also the presence of carotid artery plaque was more common in patients with TCA (p < 0.001). There was a significant correlation between the presence of subclinical atherosclerosis and TCA (p = 0.005, R = 0.3). Likewise, a significant correlation was found between subclinical atherosclerosis and retinal artery tortuosity (p = 0.02, R = 0.3). Multivariate analysis identified female gender (p < 0.008), retinal arterytortuosity (p < 0.001), and CIMT (p = 0.02) as independent predictors of TCA. CONCLUSIONS These results indicate that, whatever the mechanism is: 1) TCA is associated with female gender and short stature; 2) TCA is associated with subclinical atherosclerosis even in patients with entirely normal appearing coronary arteries on coronary angiography; 3) Retinal artery tortuosity is correlated with TCA and can be a surrogate for systemic arterial tortuosity.

Association of male pattern baldness with angiographic coronary artery disease severity and collateral development

ObjectiveWe aimed to investigate whether there is an association between male pattern baldness and angiographic coronary artery disease (CAD) severity and collateral development, which has not been reported previously.MethodsCoronary arteriograms, CAD risk factors, lipid parameters and presence and severity of baldness in 511 male patients were prospectively evaluated. Baldness was classified into five groups. Severity of CAD was evaluated with the Gensini scoring system and collateral development with Rentrop scores.ResultsAlthough subjects with a higher Gensini score had more frequent and severe baldness, they were older than the group with lower Gensini scores. Bald patients had a higher Gensini score when compared with their non-bald counterparts. In univariate analysis, age more than 60, body mass index more than 30, smoking and baldness were predictors of high Gensini scores. In multivariate analysis, only age more than 60, body mass index more than 30 and smoking were independent predictors of a high Gensini score. There were no differences in terms of presence and severity of baldness in subjects with and without adequate collateral development.ConclusionsThere was no relation between presence, severity and age of occurrence of male pattern baldness and Gensini and Rentrop scores, which are important measures of presence and severity of CAD.