Suzi Selim Ayhan

Predictive value of mean platelet volume in young patients with non-ST-segment elevation acute coronary syndromes: a retrospective observational study

OBJECTIVE Platelets play an important role in both initiation and propagation of acute coronary syndromes. We sought to evaluate the predictive value of mean platelet volume (MPV) in young patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS This is a retrospective observational study; evaluating the MPV values of 79 NSTE-ACS patients aged under 45 years and 45 control subjects having normal coronary anatomy. NSTE-ACS group was composed of 41 non-ST elevation myocardial infarction (NSTEMI) and 38 unstable angina pectoris (USAP) patients. MPV was measured using an automated hematologic analyzer called Coulter counter. The predictive value of MPV was evaluated using logistic regression analysis and comparison of MPV between NSTE-ACS and control groups was performed by Mann-Whitney U test. RESULTS The MPV was found to be significantly higher in the NSTE-ACS compared with control group (8.49±1.22 versus 7.78±0.65 fL, p=0.001). In logistic regression analysis, MPV was found to be an independent predictor of NSTE-ACS (OR=3.1, 95% CI 1.2-8.2, p=0.022). The MPV values of NSTEMI group were not significantly different from USAP group (8.78±1.38 versus 8.17±0.95 fL, p=0.66). Similarly, the MPV values of the 3 groups (Control, USAP and NSTEMI) were found to be significantly different (7.78±0.65, 8.18±0.95, 8.78±1.38 fL respectively, p=0.001). CONCLUSION In conclusion, MPV was found to be elevated in NSTE-ACS patients compared with control subjects in young population. In addition, increased MPV was established to be an independent predictor of NSTE-ACS.

Electrophysiological validation of total atrial conduction time measurement by tissue doppler echocardiography according to age and sex in healthy adults.

We sought to validate total atrial conduction time (TACT) measurement via tissue Doppler imaging (TDI) by comparing the electrophysiological study (EPS) measurements of healthy subjects, according to age and sex.

Cardiac autonomic function in healthy young smokers.

The present study examined the heart rate turbulence (HRT) and heart rate variability (HRV) parameters in healthy young smokers (<40 years) to assess the effects of smoking on cardiac autonomic function. The study included 75 smokers with a history of habitual smoking for at least 1 year (41 males and 34 females; mean age, 29.3 ± 7.3 years) and 30 nonsmokers (hospital staff; 16 males and 14 females; mean age, 29.0 ± 6.1 years). Addiction to smoking was evaluated using the modified Fagerström test for nicotine-dependence index (NDI). HRT, HRV, basic clinical and echocardiographic, and Holter test parameters were compared between groups. No significant differences between the two groups were found in the basic clinical and echocardiographic variables. Turbulence onset (TO) was significantly higher in the smoking group than in the controls, and turbulence slope was significantly lower in the smokers, than in the controls (p < 0.05). Standard deviation of all normal-to-normal (NN) interval index (SDNNI) was the only HRV parameter that was significantly different between the smoking and control groups (p < 0.05). The NDI was positively correlated with the TO (p < 0.05). Smoking impairs the baroregulatory function in healthy young smokers, particularly the HRT parameters and SDNNI. Our findings highlight the importance of complete smoking cessation.

The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.

Assessment of the relationship between aortic pulse wave velocity and aortic arch calcification.

OBJECTIVES We aimed to assess arterial stiffness parameters and to investigate the relationship between these parameters and aortic calcification in patients with aortic arch calcification and without symptomatic atherosclerotic disease. STUDY DESIGN The population of this study consisted of 41 patients with aortic arch calcification verified by chest X-ray (group I, 17 males, mean age 70±5 years) and individuals without aortic arch calcification (group II, 17 males, mean age 68±6 years). Subjects with symptomatic or known vascular disease were excluded from the study. The arterial stiffness parameters of all subjects were measured non-invasively with a SphygmoCor device. Aortic pulse wave velocity (PWV), augmentation pressure (AP), augmentation index (AIx) and heart rate normalized augmentation index (AIx@75) were used as parameters of arterial stiffness. RESULTS The two groups were compared according to demographic characteristics, medications currently being taken, and levels of serum lipids. There was no significant difference between the groups. AP in group I was significantly higher than that of group II (p=0.002). AIx and AIx@75 were similar in both groups. Aortic PWV of group I was significantly higher than that of group II (p<0.0001). CONCLUSION According to the results of this study, the presence of aortic calcification, verified by chest radiography, was associated with increased aortic PWV.

Abdominal wall hematoma related to severe cough in a patient under antiaggregant and anticoagulant therapy

A 56-year-old woman with coronary artery disease presented with the complaint of chest pain. She was hospitalized with the diagnosis of acute coronary syndrome. She was taking acetylsalicylic acid, metoprolol, atorvastatin and isosorbide mononitrate for coronary artery disease. The medical history included: diabetes mellitus, hypertension, and coronary artery bypass grafting surgery. The blood pressure was 170/100 mmHg and the heart rate was 94 beats/min. There was no significant finding on physical examination other than a mild systolic murmur at the apical region. Laboratory testing revealed the following values: glucose: 87 mg/dL, troponin I: 3.07 ng/mL, CK-MB: 18.3 U/L, hemoglobin: 8.6 g/dL, thrombocyte: 247,000/ mm and INR: 1.07. Besides the existing treatment, nitroglycerine infusion, subcutaneous enoxoparine, clopidogrel, amlodipine and perindopril medication was started. On the third day of treatment, a non-productive severe cough started. It was thought to be related with the ACE inhibitor, or an upper respiratory tract infection. The ACE inhibitor medication was converted to an angiotensin receptor blocker. On the fourth day of hospitalization, severe abdominal pain and a painful right upper quadrant mass developed (Fig. 1). The hemoglobin level decreased to 8.1 g/dL. Two units of red blood cell suspension were transfused. Abdominal ultrasound examination revealed an abdominal hematoma. All of the anticoagulant and antiaggregant medications were stopped. Abdominal computed tomography was performed. A 13.4 9 8.9 cm hematoma between the right internal oblique and external oblique muscles was detected (Fig. 2). Initially, the surgeons planed an operation to ligate the bleeding vessel under general anesthesia, but, because of the high risk of the patient due to the acute coronary syndrome, they suggested conservative non-operative management. Because of the patient’s unbearable pain, percutaneous catheter placement and drainage had to be performed. Control USG revealed reduced diameters of the hematoma. The cough improved 5 days after the conversion to an angiotensin receptor blocker; this suggested that the cause of the cough was the ACE inhibitor rather than upper respiratory tract infection. The patient recovered and was discharged. Cough is a vital reflex to clear airways for pulmonary clearing. Abdominal muscles suddenly contract to increase

PP-119 Treatment of Atrial Fibrillation with Pulmonary Vein Isolation: A Single Center Experience

The American Journal of Cardiology MARCH 26e29, 2015 11 IN AND C Acute procedural success rate ( 3 PV isolation) was 97.2 % with radiofrequency technique (82.2% paroxysmal AF, 18.8% persistan AF). Major complications were observed in one of patients which treated with radiofrequency technique (cardiac perforation). PVI with radiofrequency, mean procedural and fluoroscopy times were 124.2 25.2 (110-210) min and 15.3 6.3 (14-23) min. Additionally, 4 of patients which treated with radiofrequency technique mitral isthmus and roof ablation line were performed together with PVI. At the time of followup, 93.28% of patients were free from AF recurrence. Conclusion: The efficacy and safety of radiofrequency and cryoballoon AF ablation technique was shown due to the acceptable success and low complication rates in either paroxysmal or permanent AF patients. A number of the complications early in the experience of PVI isolation have been addressed, especially with radiofrequency PVI, but further experience is required to increase the efficacy and safety of these techniques.

The comparison of demographic and clinical specialty in Patients with Electrophysiologic Study; two different centers

Özet Abstract Amaç: Bu çalışmamızda ülkemizin iki değişik bölgesinde yer alan biri Doğu Anadolu Bölgesinden devlet hastanesi diğeri üniversite hastanesi olmak üzere iki farklı EPS laboratuvarında (R1: Doğu Anadolu, R2: Batı Karadeniz) işleme alınan hastaların retrospektif olarak belirlenen klinik ve demografik özelliklerini karşılaştırmayı amaçladık. Yöntem: Her iki merkezde, çarpıntı yakınması ile Ocak 2010 ile Mayıs 2012 tarihleri arasında EPS işlemine alınan toplam 441 hastalanın kayıtları klinik ve demografik özellikleri açısından retrospektif olarak incelendi. Bulgular: R1’de EPS işlemine alınan hastaların %70,04 (n=188), R2’de işleme alınan hastaların ise %64,36 (n=112) kadın cinsiyetti. (p=0.184). R2’deki hastaların %23,3’ü düşük gelir grubunda iken, %59,2’si orta gelir grubunda ve %17,5 yüksek gelir grubunda idi. R1’de ise %39,6’sı düşük gelir grubunda iken, %49,4’si orta gelir grubunda ve %11 yüksek gelir grubunda idi (p=0.031). R2’deki hastaların %3,4’ü okur yazar, %21,1 ortaöğretim, %45,6 lise ve %29,9’u ise yükseköğretim grubunda iken, R1’deki hastaların %2,3’okur yazar, %43,2 ortaöğretim, %42,6 lise ve %11,9 yükseköğretim grubunda idi (p=0.042). Sonuç: Farklı merkezlerde yapılan EPS işlemlerindeki hasta profillerinin oluşmasında sosyoekonomik ve eğitimsel statününde rol alabileceğini düşünmekteyiz. Background: In this study, we present the comparison of demographic and clinical specialty in Patients with Electrophysiologic Study (EPS) from two different centers (R1: Government Hospital from East Region; R2: University Hospital from West Karadeniz Region). Method: Totally of 441 records of patients who presented with palpitation and underwent Electrophysiologic Study were analyzed retrospectively in two different centers between January 2010 and May 2012. Results: Of these patients, 70,04 % (n=188) from R1, and 64,36 % (n=112) from R2 were female (p=0.184). There were statistical significance between the Socioeconomic status (SES) and educational status (ES) (R1-R2 SES 39,6%-23,3% low, 49,4%-59,2% middle, 11%-17,5% high; p=0.031; R1-R2 ES 2,3%-3,4% literacy, 43,2%-21,1% elementary, 43,2%45,6% secondary, 11,9%-29,9% higher; p=0.042). Conclusion: We thought that Socioeconomic status and educational status have some roles about the formation of Electrophysiologic Study patients population for different centers.

Mean platelet volume could not predict infarct size in patients with acute ST elevation myocardial infarct

Amac: Artmis ortalama trombosit hacmi ile akut koroner sendrom arasindaki iliski bilinmektedir. Bu calismada ST elevasyonlu miyokard infarktusu (STEMI) ile basvuran hasta- larda sintigrafik olarak tespit edilen infarkt buyuklugu ile ortalama trombosit hacmi arasindaki iliskinin belirlenmesi amaclanmistir. Yontem: : Akut ST elevasyonlu MI ile hastaneye kabul edilen ve hastane kayitlarindan SPECT analizi olan 54 hasta ( 31 adet Anterior MI, 23 adet Inferior MI ) calismaya dahil edildi. Hastalarin basvuru aninda ve 24, 48, 72 saat sonrasinda periferik venoz kandan alinan serum ornekleri ile hemogram, serum kardiyak kreatin kinaz miyokardiyal band ( CK-MB ) ve troponin T ( cTnT ) duzeyleri laboratuar kayitlarindan elde edildi. Trombosit sayisi, ortalama trombosit hacmi ve kardi- yak enzim duzeyleri kaydedildi. Miyokardiyal nekroz alaninin buyuklugu SPECT analizi ile hesaplandi. Bulgular: Pik CK-MB ve cTnT duzeyleri (ornek alinan her uc gun icin ayni sonuc gecerli olmak uzere) sintigrafik infarkt alani ile pozitif iliskili iken, ortalama trombosit hacmi ile iliskili bulunmadi (P=0,021, P<0,0001, P=0,839, sirasiyla). Sonuc: Bu arastirma ST elevasyonlu MI sonrasi infarkt bu- yuklugunu ile ortalama trombosit hacmi arasinda iliski olma- digini ortaya koymaktadir. Boylelikle ortalama trombosit hacminin infarkt alani buyuklugunun bir ongordurucusu olmadigi gorulmektedir. Background: Increased mean platelet volume has been shown to associate with acute coronary syndromes. Aim of this study, to investigate the relationship between scinti- graphic infarct size and mean platelet volume after acute ST elevation myocardial infarction (STEMI), which has not been studied with imaging tools. Method: Fifth-four patients with acute STEMI (31 patients with anterior and 23 patients with inferior) were included in the study who were performed single photon emission computed tomography (SPECT). In all cases, venous periph- eral blood samples for hematologic and biochemical meas- urements were drawn. Platelet count, mean platelet vol- ume, creatine kinase-myocardial band protein (CKMB pro- tein), and cardiac troponin (cTnT) were obtained at admis- sion and daily during the first 72 h after a patients arrival by laboratory record. The severity scores of infarct size were calculated by SPECT. Results: Peak CKMB-protein, peak cTnT were positively correlated with, scintigraphic infarct size but mean platelet volume was not correlated with scintigraphic infarct size (P=0,021, P<0,0001, P=0,839 respectively). Conclusion: Our study suggests that there is no direct rela- tionship between mean platelet volume and myocardial infarct size. Thus, mean platelet volume does not predict of infarct size.