Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm.

ABSTRACT: Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.

The association between thrombotic and inflammatory biomarkers and lower-extremity peripheral artery disease.

Lower-extremity peripheral artery disease (LEAD) is associated with increased rates of mortality and morbidity. The aim of this study was to evaluate the associations among inflammatory and thrombotic markers and lower-extremity peripheral disease. A total of 280 patients were enrolled in this study. Of these patients, 152 patients had LEAD on peripheral angiography that was performed because of suspected lower-extremity peripheral disease based on history, physical examination, and non-invasive tests. The control group consisted of 128 patients without LEAD on peripheral angiography. Patients with LEAD were classified according to trans-atlantic inter-society consensus (TASC) II classification. Subsequently, patients in TASC A to B were defined as having mild to moderate peripheral artery disease, and those in TASC C to D were defined as having advanced peripheral artery disease. Thrombotic and inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the high-sensitivity C (hs-C) reactive protein level, the monocyte-to-high-density lipoprotein-cholesterol ratio, the fibrinogen to albumin ratio (FAR), and whole-blood viscosity at high shear rate (HSR) and low shear rate (LSR), were evaluated in this population. The NLR, the monocyte-to-high-density lipoprotein-cholesterol ratio, the FAR, and whole-blood viscosity, both at a LSR and a HSR, were significantly higher in patients with lower-extremity peripheral disease compared with patients without lower-extremity peripheral disease. We determined that lower-extremity peripheral disease severity was correlated with the NLR, monocyte-to-high-density lipoprotein-cholesterol ratio, FAR, whole-blood viscosity at LSR, and whole-blood viscosity at HSR (r = 0.719, P = .004; r = 0.25, P = .008; r = 0.691, P = .002; r = 0.546, P < .001; and r = 0.448, P = .001, respectively). However hs-C reactive protein levels were similar between patients with or without LEAD (2.47 ± 1.32 1.61 ± 0.91 P = .685). In addition, there was no correlation between the severity of LEAD and hs-C reactive levels. In this study, we determined that the levels of inflammatory and thrombotic biomarkers are elevated in peripheral artery disease, and these levels predict disease severity.

The association between the fibrinogen-to-albumin ratio and coronary artery disease severity in patients with stable coronary artery disease.

OBJECTIVE: Fibrinogen-to-albumin ratio (FAR) is an inexpensive and easily measurable novel inflammatory index that has been found to be associated with atherosclerosis. In this study, we aimed to investigate the association between the FAR and coronary artery disease (CAD) severity in patients with stable CAD. METHODS: In total, 356 consecutive patients with CAD were classified into three groups, those with a low Synergy between percutaneous coronary intervention and the Taxus and Cardiac Surgery Study (SYNTAX) score (≤22), those with an intermediate SYNTAX score (23≥ SYNTAX score ≤32) and those with a high SYNTAX score (>32). RESULTS: We determined that there were significant differences in the mean age (P < 0.001), male gender (P = 0.008), serum fibrinogen (P = 0.03), low-density lipoprotein cholesterol (P < 0.001) and FAR (P < 0.001) among the SYNTAX score groups. A strong positive correlation was detected between FAR and SYNTAX score (r = 0.899; P < 0.001), and the cutoff level of FAR for high SYNTAX score was 82 (sensitivity of 82%, specificity of 88.3% and an area under the curve of 0.826). CONCLUSION: The novel inflammatory index, FAR, is significantly associated with the severity of CAD in patients with stable CAD.

Blood Group Types O and Non-O Are Associated With Coronary Collateral Circulation Development.

Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.

The Usefulness of Admission Plasma NT-pro BNP Level to Predict Left Ventricular Aneurysm Formation after Acute ST-Segment Elevation Myocardial Infarction / Utilidade do Nível de NT-Pro-BNP no Plasma à Internação em Predizer a Formação de Aneurisma do Ventrículo Esquerdo após Infarto Agudo do Miocárdio com Elevação do Segmento ST

Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

Resumo Fundamento: O aneurisma do ventrículo esquerdo (AVE) é uma importante complicação do infarto agudo do miocárdio (IAM). Objetivo: Investigar o papel da porção N-terminal do pró-hormônio do peptídeo natriurético do tipo B (NT-proBNP) para predizer o desenvolvimento de AVE após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Incluímos prospectivamente 1519 pacientes consecutivos com IAMCST. Os pacientes foram divididos em dois grupos de acordo com o desenvolvimento de AVE nos seis meses após o infarto do miocárdio. Os pacientes com ou sem AVE foram examinados para determinar se existia uma relação significativa entre os valores basais do NT-proBNP e as características clínicas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: O AVE foi detectado em 157 pacientes (10,3%). O nível basal do NT-proBNP foi significativamente maior em pacientes que desenvolveram AVE após IAM (523,5 ± 231,1 pg/mL vs. 192,3 ± 176,6 pg/mL, respectivamente, p < 0,001). Os preditores independentes da formação de AVE após IAM foram idade > 65 anos, tabagismo, classe Killip > 2, cirurgia de revascularização miocárdica anterior, insuficiência cardíaca pós-infarto do miocárdio, fração de ejeção do ventrículo esquerdo < 50%, falha de reperfusão, fenômeno de no-reflow, pico de troponina I e CK-MB e NT-proBNP > 400 pg/mL na internação. Conclusões: Nossos achados indicam que o nível plasmático do fragmento N-terminal do peptídeo natriurético tipo B na admissão, entre outras variáveis, fornece informações preditivas valiosas sobre o desenvolvimento de AVE após o IAMCST agudo.

The Usefulness of Admission Plasma NT-pro BNP Level to Predict Left Ventricular Aneurysm Formation after Acute ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). METHODS: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. RESULTS: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. CONCLUSIONS: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.

Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease.

BACKGROUND: Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease. METHODS: This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality. RESULTS: During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 ± 1.6 g/dL vs. 13.7 ± 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 ± 8.4 years vs. 68.6 ± 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 ± 85.6 and 126.8 ± 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis. CONCLUSION: In our study, higher PLR was associated with increased all-cause mortality.

Angiographic restenosis in ephesos coronary stents: experience from a large medical center in Ankara, Turkey.

Coronary stent restenosis, which emerges in late periods after implantation, has not been completely abolished. Our aim was to investigate the restenosis rates of Ephesos coronary stents. In all, 96 patients (66 men) with 135 Ephesos coronary stents were included. Control angiograms were performed after 160 +/- 60 days. Quantitative coronary analysis was performed during the procedure and control angiogram. The stents were divided into 2 groups according to the presence or absence of restenosis. Groups were compared with clinical and angiographic variables. Restenosis was observed in 31 (23%) of 135 stents. Preprocedure percent diameter stenosis was higher (P = .02), whereas minimum lumen diameter ( P = .02), mean age (P < .001), and hypertension incidence ( P = .043) was less, and there was a trend toward smaller stent size ( P = .054) in the restenosis group. By multivariate analysis, age <50 years (P < .001) and stent size <3.0 mm (P = .016) were independent predictors of restenosis. Ephesos coronary stents seems to have acceptable restenosis rates.

Three unusual myxomas originating from the left atrial appendage: a case report.

Most left atrial appendage masses have been reported to be thrombus, particularly in the presence of atrial fibrillation. The presence of any mass other than thrombus is extremely rare in the left atrial appendage. This report presents the rare case of a 70-year-old woman presenting with paroxysmal atrial fibrillation and syncope who was given the diagnosis of having 3 myxomas originating from the left atrial appendage. The diagnosis was established by the help of transesophageal echocardiography and confirmed by histologic examination after operation. The advantage of transesophageal echocardiography in this case and for patients with atrial fibrillation is emphasized.

Altered coronary flow properties in diffuse coronary artery ectasia.

OBJECTIVES: The purpose of this study was to investigate coronary blood flow properties in patients with diffuse coronary artery ectasia (CAE) associated with exercise-induced myocardial ischemia. METHODS: Seventeen patients with diffuse CAE and without coexisting coronary artery stenosis were enrolled in the study (CAE group). CAE was defined as luminal dilatation 1.5 to 2 times that of the adjacent normal coronary artery segment or the diameter of the corresponding coronary artery of the control group when there was no normal segment. The age- and sex-matched control group (n = 20) comprised patients with normal epicardial coronary arteries. Coronary blood flow velocities were obtained invasively by use of Doppler scanning flow wire. Coronary flow reserve (CFR) was measured by administration of intracoronary papaverine as the hyperemic stimulus. Volumetric coronary blood flow was estimated by multiplying the velocity time integral of coronary blood flow with the cross-sectional area of the coronary artery and the heart rate. RESULTS: Fifteen patients with CAE, but none of the patients in the control group, had electrocardiographic signs of myocardial ischemia at peak exercise on ergometry. Baseline average peak velocities (APVs) of coronary blood flow were similar in the 2 groups. Peak hyperemic APVs of coronary blood flow were lower in the CAE group than in the control group (17.5 +/- 7.4 cm/s vs 41.5 +/- 12.6 cm/s, respectively, P <.001). Volumetric coronary blood flow was significantly higher in the CAE group than in the control group, both at rest and at hyperemia (146.3 +/- 71.2 cm3/min vs 45.1 +/- 16.1 cm3/min, respectively, P <.001, and 202 +/- 87.3 cm3/min vs 104.1 +/- 37.6 cm3/min, respectively, P <.003). The mean CFR of the CAE group was significantly reduced compared with that of the control group (1.51 +/- 0.31 vs 2.67 +/- 0.52, respectively, P <.001). CONCLUSIONS: The CFR is significantly reduced in patients with diffuse CAE compared to a matched control group. Although volumetric coronary blood flow is significantly higher in CAE, microcirculatory dysfunction that is reflected as depressed CFR may be the underlying cause of exercise-induced myocardial ischemia.

Hyperhomocysteinaemia and coronary artery disease in the Turkish population.

OBJECTIVE: Many studies have demonstrated a strong association between elevated plasma total homocysteine (Hcy) levels and vascular disease. The objective of this study was to examine the relation between homocysteine levels and coronary artery disease in Turkish patients. METHODS AND RESULTS: In this study plasma homocysteine levels were measured in control and patient groups. A significant coronary artery lesion was defined as a stenosis of > or = 70% as shown by coronary angiography and determined by on-line quantitative measurements; treatment was by coronary angioplasty. Total plasma Hcy level was measured before the coronary intervention. Plasma homocysteine levels were measured by an HPLC method in patients with a definite diagnosis of coronary artery disease and compared with age- and sex-matched controls. Patients with coronary artery disease had significantly higher mean homocysteine concentrations than control subjects (geometric mean +/- 95% CI: 12.5 +/- 1.1 micromol/l vs. 8.60 +/- 1.07 micromol/l, p<0.001). Eighty-three (59%) members of the patient group and 14 (21%) members of the control group had plasma homocysteine concentrations above the 11.3 micromol/l, which represents the concentration which includes the uppermost quintile of the control group distribution (odds ratio 4.35, 95% CI; 2.1-8.94). CONCLUSION: Results of this study indicate that high plasma levels of homocysteine in Turkish subjects are associated with coronary artery disease. Our data suggest that focusing public health initiatives on this issue may reduce the high prevalence of cardiovascular disease in the Turkish population.