Veysel Kutay Vurgun

Comparison of a qualitative measurement of heart-type fatty acid-binding protein with other cardiac markers as an early diagnostic marker in the diagnosis of non-ST-segment elevation myocardial infarction.

Summary Objective: Heart-type fatty acid-binding protein (H-FABP) is a novel cardiac marker used in the early diagnosis of acute myocardial infarction (AMI), which shows myocyte injury. Our study aimed to compare bedside H-FABP measurements with routine creatine kinase-MB (CK-MB) and troponin I (TnI) tests for the early diagnosis of non-ST-elevation MI (NSTEMI), as well as for determining its exclusion capacity. Methods A total of 48 patients admitted to the emergency room within the first 12 hours of onset of ischaemic-type chest pain lasting more than 30 minutes and who did not have ST-segment elevation on electrocardiography (ECG) were included in the study. Definite diagnoses of NSTEMI were made in 24 patients as a result of 24-hour follow up, and the remaining 24 patients did not develop MI. Results When various subgroups were analysed according to admission times, H-FABP was found to be a better diagnostic marker compared to CK-MB and TnI (accuracy index 85%), with a high sensitivity (79%) and specificity (93%) for early diagnosis (≤ six hours). The respective sensitivities of bedside H-FABP and TnI tests were 89 vs 33% (p < 0.05) for patients presenting within three hours of onset of symptoms. Conclusion Bedside H-FABP measurements may contribute to correct early diagnoses, as its levels are elevated soon following MI, and measurement is easy, with a rapid result.

Prediction of recurrence after cryoballoon ablation therapy in patients with paroxysmal atrial fibrillation

Objective: The purpose of this study was to investigate the factors predicting the maintenance of sinus rhythm in patients with paroxysmal atrial fibrillation (PAF) who underwent cryoablation of the pulmonary veins (PVs). Methods: Fifty-one patients (54.6±10.4 years) with paroxysmal AF who underwent the cryoablation of the PVs were to the prospective trial. The clinical risk factors and echocardiographic parameters [left atrial (LA) diameter, left ventricular ejection fraction and dimensions, left atrial spontaneous echo contrast (LASEC), mitral annulus calcification (MAC), left atrial appendage emptying peak flow velocity (LAAV), and PV flow] were assessed before the cryoablation procedure. Patients with PAF who refused to use any medication because of intolerance or presentation of resistant symptoms, despite the use of at least one antiarrhythmic drug were enrolled to the study, patients with LA/LAA thrombus on echocardiographic examination, severe valvular disease, pericardial fluid, and abnormal thyroid function tests as well as systemic disease were excluded from the study. All parameters were tested for their ability to predict the recurrence of AF during a 1-year follow-up period. Results: During the period of follow-up, AF recurred in 16 of 51 patients (31.3%/year). All significant parameters associated with the recurrence of AF were evaluated in multivariate logistic regression analysis. The presence of MAC (p<0.001) as well as LA diameter (p<0.0001), LAAV of <30 cm/s (p<0.0001), PV flow systolic wave velocity (p<0.0001), and LASEC (p<0.0001) were detected as independent predictors of recurrence. In the receiver operating characteristic analysis, LAAV of >30 cm/s had a sensitivity of 85% and a specificity of 95% for predicting success after ablation (AUC=0.813; 95% CI:0.76–0.92; p<0.0001). Conclusion: The presence of MAC, increased LA diameter, the existence of LASEC, low LAAV, and low peak PV systolic wave velocity are parameters that can predict the recurrence of AF after cryoablation.

Red cell distribution width as a predictor of left atrial spontaneous echo contrast in echocardiography.

AbstractRed cell distribution width (RDW) represents the heterogeneity of red blood cells (anisocytosis). Spontaneous echo contrast (SEC) is thought to be a manifestation of red cell aggregation and it has been linked to the development of thromboemboli. The aim of this study was to evaluate the association between RDW levels and the presence of left atrial SEC (LASEC).One-hundred and 72 patients who underwent transesophageal echocardiography for various indications were enrolled in the study. All patients were categorized into 2 groups according to the presence of LASEC and into 4 groups according to the severity of LASEC. The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups.The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001). When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001). In the ROC analysis, an RDW level >13.8% had 70% sensitivity and 89.2% specificity in predicting LASEC (area under the curve = 0.834, P < 0.0001, 95% CI 0.656–0.773). In multivariate analysis, RDW levels >13.8% and the presence of atrial fibrillation were independently associated with LASEC (odds ratio [OR] 1.697; 95% confidence interval [CI] 1.198–2.085; P = 0.001 and OR 1.586; 95% CI 1.195–2.098; P = 0.003, respectively].Elevated RDW value is associated with the presence and the severity of SEC. RDW may be a useful marker and independent predictor for the presence of SEC.

Extrathoracic subclavian-axillary vein location and morphological features over the first rib for pacemaker and defibrillator lead implantation

We aimed to describe the variations of extrathoracic subclavian‐axillary vein location and its morphology over the first rib by venography in order to facilitate venous puncture using fluoroscopic landmarks without contrast venography, and evaluate the success rate of punctures, which is made with our method.

Atrioventricular block in siblings with argininosuccinic aciduria

Argininosuccinic aciduria (ASA) is an autosomal recessively inherited,complex inborn error of the urea cycle, caused by deficiency inargininosuccinate lyase [1]. The estimated prevalence of ASA is reportedas 1 in 70,000 live births [2]. Patients with ASA are at risk for long-termcomplications of hyperammonemia which may be manifested asneurocognitivedeficitsandhepaticdysfunction.Theuniquereportedcar-diovascular complication associated with ASA has been systemic hyper-tension [3]. Here, we present two siblings with diagnosis of ASA whowere hospitalized with symptomatic bradycardia.The first patient is a 25-year-old male who has diagnosed with ASAat childhood. He was born vaginally after full-term pregnancy with nohistory of birth trauma or perinatal anoxia. The growth of the subjectwas retarded with values less than 5th percentile. He displayed behav-ioral abnormalities, learning disabilities and seizures during childhood.Because of elevated hepatic enzyme activities, hyperammonemia(400 mcg/dL) and mentioned neurologic complications he had under-gone an investigation for ASA. Plasma citrulline level was 248 μmol/L

Bare-metal stent thrombosis two decades after stenting.

Abstract Very late bare-metal stent (BMS) thrombosis is unusual in clinical practice. To the best of our knowledge, the latest that the thrombosis of a BMS has been reported is 14 years after implantation. Here, we describe a case of BMS thrombosis that occurred two decades after stenting. A 68-year-old male patient was admitted with acute anterior myocardial infarction. This patient had a history of BMS implantation in the left anterior descending coronary artery (LAD) 20 years previously. Immediate coronary angiography demonstrated acute thrombotic occlusion of the stent in the LAD. With this case, we are recording the latest reported incidence of BMS thrombosis after implantation.

Percutaneous transapical approach and transcatheter closure for ventricular tachycardia ablation: VURGUN et al.

Yes, there is. The need for epicardial ablation has been reported in 10–15% of patients with ischemic cardiomyopathy,1 25–50% of patients with nonischemic cardiomyopathy (NICM),2 and 30–40% of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).3 Epicardialmapping and ablation is nowcommonly performed in experienced centerswhen an epicardial ventricular tachycardia (VT) is suspected. In patients with NICM and ARVC, endoand epicardial mapping and ablation are frequently performed in combination since these patients have a higher likelihood of epicardial involvement.2 Epicardial ablation is more frequently required in patients referred after failed VT ablation.4 Our patient had hypertrophic cardiomyopathy, and we were aware of epicardial arrhythmic substrate. We consulted this case to the cardiovascular team to open pericardial window for epicardial VT ablation. But, due to supposed pericardial adhesions and high surgical risk, epicardial approachwasnot planned.Weperformed transapical access and an extensive ablation concept endocardially, including to ablate diastolic potentials and low-voltage areas and to create deeper lesions with long-time and high-voltage ablation for intramural and epicardial arrhythmic substrate.

Extrathoracic subclavian-axillary vein location over the first rib for pacemaker and defibrillator lead implantation: VURGUN et al.

We took these images to show that the position of the axillary vein over the first rib is not changed with the shoulder movement in our study.We recommend the “neutral” shoulder position when you puncture to the axillary vein. In some cases, the axillary vein puncture can be difficult when the clavicle is located caudally and completely covers the first rib. In this case, the puncture area on the first rib will come into view by moving the shoulder cranially, and the puncture can be performed over zone 2 (lateral), but this maneuver increases the risk

Percutaneous transapical approach and transcatheter closure for ventricular tachycardia ablation

In patients with mechanical aortic and mitral valve prosthesis, left ventricular endocardial ablation via retrograde transaortic or antegrade transmitral approach carry high risk of catheter entrapment and death. In such cases, ablation can be performed via ventricular transseptal or transapical approach. Transapical approach, with the ease of catheter maneuverability and better endocardial contact, may be performed surgically or percutaneously. In this case report, we describe a patient with both aortic and mitral mechanical prosthesis who underwent ventricular tachycardia ablation via percutaneous transapical endocardial approach with the use of closure device.

Serum neuron-specific enolase, a marker of neuronal injury, increases after catheter ablation of atrial fibrillation

Objective Catheter ablation of atrial fibrillation (AF) can lead to thromboembolic complications, especially stroke. We measured the periprocedural serum neuron-specific enolase (NSE) level, which is a biomarker of neuronal injury, after ablation of AF. Methods Forty-three patients with paroxysmal AF were prospectively enrolled before radiofrequency ablation. A neurological examination was performed before and after the procedure. The serum NSE level was determined before and at the end of the procedure and at 2, 24, and 48 h after the procedure. Results No patients developed new neurological deficits. However, the median (interquartile range) NSE level increased after ablation from 6.7 (3.87) ng/mL at baseline to 11.48 (5.3) ng/mL at 24 h postoperatively. The NSE level exceed the upper reference limit of normal (17 ng/mL) in 14 patients (33%), and these patients were found to have a larger left atrium. Conclusions Serum NSE increased in most of the patients undergoing ablation for AF, and it exceeded the normal limit in one-third of the patients. Although NSE is a biomarker of neuronal injury, the clinical importance of this increase after AF ablation and its relationship with the left atrial diameter should be evaluated in a longitudinal study.