Ulas Bildirici

Comparison of the long-term prognostic value of Cystatin C to other indicators of renal function, markers of inflammation and systolic dysfunction among patients with acute coronary syndrome

OBJECTIVE Emerging evidence indicates the prognostic importance of cystatin C (Cys-C) in patients with coronary artery disease. However, whether Cys-C concentrations are associated with adverse clinical events among patients with acute coronary syndromes (ACS) have not been studied extensively. We compared the long-term prognostic efficacy of Cys-C with other markers of renal dysfunction, inflammation and systolic dysfunction in patients with ACS. METHODS AND RESULTS Serum levels of Cys-C, high sensitive C-reactive protein (hs-CRP), brain natriuretic peptide (BNP) and creatinine were measured in 160 patients with ACS (112 males, 48 females, mean age 60+/-10 years) on admission. Primary end point of the study was major adverse cardiac events (MACE) defined as the combination of cardiac death, non-fatal myocardial infarction and recurrent rest angina that required hospitalization within 12 months of follow-up. During the follow-up period, 42 (26%) patients met the MACE criteria. The occurrence of MACE was significantly higher among patients with higher Cys-C levels. In multivariate analysis, Cys-C was the most important parameter associated with the occurrence of MACE (OR=9.62, 95% CI=2.3-40.5, p<0.001). ROC curve analysis showed that the predictive cut-off value of Cys-C for MACE was 1051ng/ml. In the Cox regression analysis adjusted for multiple risk factors, Cys-C was found as the most powerful predictor for MACE (RR=9.43, 95% CI=4.0-21.8, p<0.001). CONCLUSION The results of the present study indicate that admission levels of Cys-C may be a good prognostic indicator of recurrent cardiovascular events in patients with ACS. Further studies are needed to confirm these results.

Evaluation of Left Atrial Appendage Functions According to Different Etiologies of Atrial Fibrillation with a Tissue Doppler Imaging Technique by Using Transesophageal Echocardiography

Background: Atrial fibrillation (AF) occurs due to various etiologies that carry different risks for thromboembolism. However, the effect of different etiologies on left atrial appendage (LAA) function has not been investigated. This study aimed to examine the LAA function in AF that occurred under various etiologies and to compare the findings with a novel tissue Doppler imaging (TDI) technique by using transesophageal echocardiography (TEE). Methods: LAA function was assessed in 84 patients with permanent AF according to various etiologies [mitral stenosis in 20 (24%), hypertension in 44 (52%), and hyperthyroidism in 20 (24%) patients] and in 23 controls with sinus rhythm. LAA area change, PW‐Doppler and tissue velocities of LAA were measured. The presence of SEC or thrombus and their relation to LAA function was evaluated. Results: LAA velocities were lowest in mitral stenosis and highest in hyperthyroidism. Moderate–severe LAA SEC was detected in 61 and thrombi in 23 patients. Factors associated with the severity of SEC were the percentage of the LAA area change, PW‐Doppler peak emptying velocity, and TDI septal wall downward velocity. The percent of the LAA area change and PW‐Doppler peak emptying velocity were the significantly related factors for the presence of thrombi (OR = 0.84, 95% CI = 0.74–0.95, P = 0.005 and OR = 0.85, 95% CI = 0.74–0.98, P = 0.02, respectively). Conclusion: LAA function deteriorated most severely in mitral stenosis and least in hyperthyroidism. The LAA area change and PW‐Doppler emptying velocity were important predictors for SEC or thrombi. Although TDI was not superior to classical methods, it provided complementary data to PW‐Doppler velocities for predicting SEC and thrombi.

Long-term prognosis of non-interventionally followed patients with isolated myocardial bridge and severe systolic compression of the left anterior descending coronary artery.

The aim of this study was to investigate the long‐term prognosis of non‐interventionally followed patients with myocardial bridge and angiographic milking of the left anterior descending (LAD) coronary artery.

Effect of cardiac resynchronization therapy on left ventricular diastolic filling pattern in responder and nonresponder patients.

Background: The aim of this study was to investigate the short‐ and long‐term effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) diastolic filling pattern and the relation between the diastolic filling pattern and the response to CRT.

Essential Thrombocythemia: A Case of Acute ST‐Segment Elevation Myocardial Infarction in a Young Female

Essential thrombocythemia (ET) is a clonal disorder of the myeloid stem cell that causes abnormal proliferation of the megakaryocytes. The main feature of the disease is arterial and venous thrombosis caused by platelet dysfunction. Coronary artery involvement leading to acute coronary syndromes is a rare complication of the ET. We report a coronary angioplasty and stenting in a 30‐year‐old female patient with acute ST‐segment elevation myocardial infarction (MI) as the first clinical sign of essential thrombocythemia. Facilitated percutaneous coronary intervention with GPIIb/IIIa and/or thrombolytic therapy may be considered as the first treatment modality for this patient group. Copyright

Persistent Left Superior Vena Cava and Partial Anomalous Pulmonary Venous Return in an Old Asymptomatic Female Patient

Persistent left superior vena cava is a rare congenital venous anomaly. It results from failure of closure of the left anterior cardinal vein during cardiac development. It is usually asymptomatic but can be associated with other congenital cardiac defects including atrial septal defects, ventricular septal defects, endocardial cushion defects, tetralogy of Fallot and rhythm disturbances. PLSVC should be considered in the presence of a dilated coronary sinus on transthoracic echocardiography. The diagnosis can be made when injection of contrast in left antecubital vein results in enhancement of the dilated coronary sinus before right atrium. MRI, CT-scan and catheterisation can be used to confirm the diagnosis.

Asymptomatic malposition of pacemaker lead associated with thrombus

permanent VDD pacamaker implantation for symptomatic bradycardia 9 years ago at another institution, was admitted to the hospital for pacemaker battery change. Physical examination revealed blood pressure of 110/80 mmHg, heart rate of 50 bpm, respiratory rate of 20 breaths per minute. A grade III/ VI pansystolic murmur with maximal intensity was heard at the left sternal border. Electrocardiography showed ventricular pacemaker spikes followed by right bundle branch block pattern. Posterior-anterior chest X-ray suggested atypical lead position. The pacemaker battery was changed successfully and pacemaker functions were normal. Transthoracic echocardiography was done as a routine follow-up before discharge. Transthoracic echocardiography revealed left ventricular hypertrophy, left atrial and right ventricular dilatation, a central type ventricular septal defect with a diameter of 5 mm (maximal gradient = 46 mmHg, Qp/Qs = 1.3) and a patent foramen ovale with the ventricular lead crossing the defect (Fig. 1). Transesophageal echocardiography revealed a thrombus with a 5 · 6 mm diameter in the interatrial septum (Fig. 2). Coronary angiography revealed normal coronary arteries and Qp/Qs was 1.35. The patient had a history of pacemaker battery change in 2002 and had normal lead functions on routine follow-up. The patient underwent surgical lead extraction and closure of the patent foramen ovale without any complication. Ventricular septal defect was not repaired. After surgery VDD pacemaker was implanted with success.

Comparison of the effects of left vs. right ventricular pacing on left ventricular remodelling

AIMS Patients having conduction disease and indications for a standard pacemaker implantation are treated with right ventricular (RV)-based pacemaker therapy. The aim of this study was to investigate echocardiographic and clinical effects of RV and left ventricular (LV)-based pacing in patients with standard pacemaker indication and LV dysfunction. METHODS AND RESULTS Thirty-nine patients with symptomatic bradycardia due to sinus or atrioventricular nodal dysfunction and having absolute standard pacemaker indication, low LV ejection fraction (EF) (35-50%) and QRS duration <120 ms were included in the study. Pacemaker properties, echocardiographic, and clinical results were evaluated in both patient groups after a long-term follow-up period. A significant increase in LVEF (left ventricular ejection fraction) was observed in left pacing group (from 37 +/- 10 to 41 +/- 9%, P < 0.01) and a statistically significant decrease in right pacing group (from 40 +/- 7 to 37 +/- 10%, P < 0.05). Intraventricular asynchrony was not developed in left pacing group, whereas significant asynchrony occurred in 73% of patients in right pacing group. New-onset interventricular asynchrony was detected in three and 10 patients in LV pacing group and RV pacing groups, respectively. Intraventricular and interventricular asynchrony was found together in seven of RV lead implanted patients. Although statistically insignificant, LV end-diastolic diameter was increased (from 56 +/- 6 to 60 +/- 6 mm) and EF was decreased (from 39 +/- 7 to 33 +/- 9%) in these patients (P = 0.07). During follow-up, 40% of patients in RV pacing group were admitted to the hospital due to heart failure in contrast to LV pacing group. CONCLUSION LV-based pacemaker implantation is more suitable for patients having standard pacemaker indications and LV dysfunction even in the absence of ventricular asynchrony.

Relationship Between Endothelial Functions and Acetylsalicylic Acid Resistance in Newly Diagnosed Hypertensive Patients

We aimed to investigate the effects and dose dependency of aspirin on endothelial functions and prevalence of aspirin resistance in newly diagnosed hypertensive patients without previous drug therapy and development of cardiac complications.

Mid-Term Outcomes of Stent Overlap in Long Total Occluded Lesions of Superficial Femoral Artery

Background Superficial femoral artery chronic total occlusion (SCTO) is a common type of peripheral arterial disease (PAD). Endovascular therapy is a treatment approach that has a poor long-term success rate in this group. The aim of this study was to compare the mid-term results of two different uses of nitinol stents in long SCTO lesions (>100 mm): the use of one long stent or two shorter stents. Material/Methods Of 154 patients who underwent percutaneous infrainguinal interventions from 2011 to 2014, a total of 170 CTO lesions were selected for this retrospective study analysis. The mean age of the study population was 63.4±10.4 years (range 29–89 years); 71.8% of the patients were male. Results Patients were divided into two groups according to the number of stents used. Patients treated with a single stent were placed into group A and patients treated with two stents were placed into group B. The stent fracture rate was significantly higher in group B compared to group A (29.2% vs. 42%). Type 1 and 2 fracture rates were higher in group A, but type 3 and 5 fracture rates were significantly higher in group B. The rate of stent restenosis was significantly higher in group B compared to group A (45.1% vs. 54.5%, p=0.05). Conclusions Mid-term patency rate was low in patients with long totally occluded superficial femoral artery (SFA) lesions. Using a long single stent had an acceptable mid-term patency rate compared to using a two stent strategy. Stent fracture seemed to be the main reason for in-stent restenosis in cases of multiple stenting. A long single stent strategy may be more appropriate and reasonable than a two stent strategy in the treatment of long SFA lesions.