Association of Meteorological Variables and Coronary Blood Flow.

We aimed to assess the impact of meteorological variables on coronary blood flow (CBF). Coronary blood flow was evaluated using the thrombolysis in myocardial infarction frame count (TFC). The association of CBF with meteorological parameters such as temperature, relative humidity, total solar radiation, atmospheric pressure, wind velocity, and total sunshine duration were investigated as well as demographic, clinical, and laboratory characteristics. Assessment of 1206 patients (median age = 53 years, 723 females) revealed the presence of slow coronary flow (SCF) in 196 patients. Daily maximum temperature [odds ratio = 0.951, 95% confidence interval = 0.916-0.986, P = .007] was the only independent predictor of the presence of SCF, whereas systolic blood pressure (ß = -0.139, P = .026), hematocrit level (ß = 0.128, P = .044), and daily maximum temperature (ß = -1.479, P = .049) were independent predictors of log10 (mean TFC). Findings of the present study suggest a role of meteorological parameters in CBF regulation.

Angiographic characteristics of coronary artery fistulas.

OBJECTIVES: Coronary artery fistula (CAF) in adults is a rare form of coronary artery anomaly. It is often diagnosed incidentally during coronary angiography. The aim of this study was to evaluate the clinical and angiographic characteristics of adult patients with CAF. STUDY DESIGN: We retrospectively reviewed the database of 70,850 patients who had undergone coronary angiography in five different invasive cardiology centers in the southeastern region of Turkey. Among them, 56 patients had CAF (39 males, 17 females, mean age: 63.7±10.4 years). Demographic data, clinical evaluation and cardiac catheterization reports were reviewed from the medical records. RESULTS: A total of 58 fistulas were detected in 56 patients; two patients (3.6%) had bilateral fistulas originating from both the left and right coronary artery. In our angiographic series, CAF prevalence was 0.08%. Dyspnea on exertion and/or angina pectoris was the most common symptom (69%). Fifteen patients (26.8%) had concomitant obstructive coronary artery disease. Coronary artery fistulas originated mainly from the left anterior descending artery (n=30, 51.7%). Others originated from the right coronary artery (n=15, 25.9%), circumflex artery (n=6, 10.3%), and right sinus of Valsalva (n=3, 5.2%). In four patients (n=4, 7.1%), multiple micro fistula were draining into the left ventricle. CONCLUSION: In our angiographic series, the prevalence of CAF was 0.08%, and the most common site of origin was the left anterior descending artery.

The impact of central blood pressure levels on the relationship between oscillometric and central blood pressure measurements: a multicenter invasive study.

The aim of this study was to investigate impact of central blood pressure (BP) levels and sex on the difference between central and upper arm oscillometric BP values. Oscillometric arterial BP measurements of 675 patients were simultaneously compared with values measured from the ascending aorta. The patients were divided into 3 groups according to systolic BP levels. The upper arm oscillometric device overestimated systolic BP (SBP) at low and medium BP levels but it underestimated SBP at high BP level. As for the effect of sex on differences in central and oscillometric BP, SBP was overestimated to a lesser degree in women than in men at low BP levels, but it was more highly underestimated in women than in men at high BP levels. The difference between oscillometric upper arm BP and aortic BP was directly affected by the patient's central BP level. In addition, the difference between central and oscillometric BP was also affected by sex factor.

Predictors of preinterventional patency of infarct-related artery in patients with ST-segment elevation myocardial infarction: Importance of neutrophil to lymphocyte ratio and uric acid level.

BACKGROUND: Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI. OBJECTIVE: To assess possible predictors of patency of IRA before primary PCI in patients with STEMI. METHODS: A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients. RESULTS: Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P<0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (ß 0.673 [95% CI 0.548 to 0.826]; P<0.001), N to L ratio (ß 0.783 [95% CI 0.683 to 0.897]; P<0.001) and EF (ß 1.033 [95% CI 1.006 to 1.061]; P=0.016). CONCLUSION: Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI.

Evaluation of the hypertensive patients in southeastern Anatolia; demographic features and target organ damage.

We investigated the socio-demographic characteristics, blood and pulse pressure, and end organ damage of hypertensive patients applying to an outpatient cardiology clinic in southeastern Anatolia. End organ damage in 100 consecutive hypertensive patients was defined by left ventricular hypertrophy, retinopathy, and albuminuria. The determined independent risk factors of left ventricular hypertrophy were advanced age and low educational level; of nephropathy were high pulse pressure and unawareness of the name of anti-hypertensive drug; and for retinopathy were high pulse pressure and female gender. In order to prevent end organ damage, the most important aspect to focus on is patient training and pulse pressure.

An investigation of the heart rate, heart rate variability, cardiac ions, troponin-I and CK-MB in men exposed to 1.5 T constant magnetic fields.

The aim of this study was to investigate heart rate (HR), heart rate variability (HRV) and other cardiac parameters in individuals who were exposed to a high static magnetic field. 30 healthy male volunteers aged between 20-30 years were included. The searching was divided into three phases: pre-magnetic field, during the magnetic field and post-magnetic field. Every phase lasted 30 minutes. Pulse, systolic and diastolic blood pressure, respiration rate and elektrocardiography (ECG), recorded for 30 minutes, in all of the individuals were measured during three phases. The men were exposed to a 1.5 T static magnetic field. The levels of Na(+), K(+), Ca(2+), Cl(-), CK-MB, troponin-I and HR and HRV parameters were investigated. There was an increase in the respiration rate, and no change in the systolic and diastolic blood pressure and pulse in the individuals exposed to the magnetic field. There was also an enhancement in the values of ions, CK-MB and troponin-I after exposure to the magnetic field. Heart rate parameters (minimum HR-I, maximum HR-I, average HR-I) were decreased and rMSSD, pNN50, power, VLF, HF, LF values increased during the magnetic field.

A comparison of blood pressure and pulse pressure values obtained by oscillometric and central measurements in hypertensive patients.

OBJECTIVE: Wide pulse pressure (PP) affects the accuracy of oscillometric blood pressure measurements (OBPM): however, the degree of this impact on different patient groups with wide PPs is unclear. This study will investigate the accuracy of OBPM in achieving target BP and PP in isolated systolic hypertension (ISH) group compared with mixed hypertension (MHT) group. METHOD: A total of 115 patients (70 with ISH and 45 with MHT) were enrolled in the study. Upper arm and wrist OBPM, obtained by OmronM3 and OmronR6 devices respectively, were compared with the simultaneously measured values from the ascending aorta. The ISH was defined as a systolic blood pressure (SBP) > or =140 mmHg and a diastolic blood pressure (DBP) <90 mmHg. MHT was defined as a SBP> or =140 mmHg and a DBP> or =90 mmHg. RESULTS: The mean central arterial blood pressure (BP) and central PP were higher in the ISH group than those in the MHT group. The upper arm OBPM underestimated the central SBP in two groups (-5 mmHg, -3 mmHg, p=0.5, respectively), but overestimated DBP in the ISH group compared with MHT patients (6.8 mmHg, 1 mmHg, p=0.04, respectively). Wrist OBPM similarly underestimated to the central SBP in each group (-16 mmHg, -19 mmHg, p=0.15), whereas the sum of overestimation of DBP was significantly higher in the ISH than in the MHT group (+6 mmHg, - 1 mmHg, p=0.001, respectively). Also, each of the devices underestimated the central PP in the ISH group (about 10 mmHg) as being higher than that of the MHT group. CONCLUSION: Oscillometric devices may be used for self-BP measurement in patients with ISH without clinically important disadvantages compared with the patients with MHT. For PP measurement in patients with ISH, there were substantial differences between intra-arterial and indirect arm BP measurements.

What seals the inflammation in acute coronary syndromes?

Inflammation plays a key role in the development of acute coronary syndromes and its consequences. Coronary stenting provides improved mortality and morbidity in appropriate cases by several routes. However the beneficial effects of the coronary stenting on inflammation remain controversial as the coronary stenting might lead to--systemically detected--local inflammatory reaction.

Myocardial noncompaction and myocardial bridging: a novel coexistence?

Noncompaction of the ventricular myocardium is an increasingly recognized unclassified congenital cardiomyopathy that is frequently misdiagnosed as dilated or apical hypertrophic cardiomyopathy. Coexistence of myocardial noncompaction and myocardial bridging might be a pitfall in the diagnosis of myocardial noncompaction as previous reports have very well elucidated the coexistence of apical hypertrophic cardiomyopathy and myocardial bridging. With this report we aimed to emphasize the significance of watchful echocardiographic evaluation in appropriate diagnosis of myocardial noncompaction.

ST-T changes in patients with acute ischemic stroke.

Electrocardiographic ST-T changes with or without troponin, CK-MB positivity are frequent clinical entities in patients with acute ischemic stroke. Recognizing electrocardiographic ST-T changes as a consequence of acute myocardial ischemia rather than as a nonspecific ECG finding of acute ischemic stroke would benefit stroke patients, since myocardial and cerebral ischemia may co-exist in the same patient due to similar pathogenetic mechanisms.

Diagnosis of the left circumflex coronary artery fistula drainage into the left ventricle by echocardiographic color Doppler flow imaging.

Congenital coronary fistula is consisted of a communication between a coronary artery and a cardiac chamber or pulmonary vessel. Congenital left coronary artery-left ventricle fistula is uncommon. A 41-year-old female patient admitted to our institution for evaluation of heart murmur etiology. A loud continuous murmur heard at the apex area was detected at auscultation. Echocardiography showed a large fistula draining into the left ventricle apex. Coronary angiography revealed fistula from left circumflex coronary artery to left ventricular cavity. Since the patient was asymptomatic and no concomitant cardiac pathology was detected, we advised endocarditis prophylaxis and medical follow-up.

Biventricular myocardial noncompaction presenting with complete atrioventricular block.

Noncompaction of ventricular myocardium has been recognized as a distinct form of cardiomyopathy with its own clinical presentation and natural history. Concomitance of either valvular pathologies or complete atrioventricular block with noncompaction of ventricular myocardium has rarely been reported. Herein, we present a case with biventricular noncompaction with significant interventricular septum involvement presenting with complete atrioventricular block, who was formerly diagnosed to have mitral and aortic insufficiency.

Association of breast arterial calcification and carotid intima-media thickness.

Breast arterial calcification (BAC) on mammography has been identified as calcific medial sclerosis of medium-sized breast arteries, and has been reported to be associated with cardiovascular risk factors, coronary artery disease, and cardiovascular mortality. Carotid intima-media thickness (C-IMT) is a well-known surrogate marker of atherosclerosis and predictor of cardiovascular morbidity and mortality. Consequently, the present study was designed to investigate the association between the presence of BAC on mammography and C-IMT. Twenty-five postmenopausal cases with BAC and 29 subjects without BAC on mammography were included in the study. Cardiovascular risk factors, number of childbirths, postmenopausal duration, and age at menopause were all noted besides detailed physical and laboratory examination. In the whole study population C-IMT was measured with B-mode ultrasound. The women with BAC had significantly increased number of childbirths, postmenopausal duration, frequency of diabetes mellitus, systolic blood pressure, fasting glucose, and CIMT (0.87 +/- 0.17 mm versus 0.60 +/- 0.19 mm) in comparison with the women without BAC (P < 0.05 for all). The C-IMT was correlated with age, number of childbirths, postmenopausal duration, presence of BAC, and serum triglyceride level (P < 0.05 for all). Independent predictors of C-IMT were the presence of BAC on mammography (beta = 0.463, P < 0.001) and serum triglyceride level (beta = 0.222, P = 0.042), whereas the only independent predictor of BAC was CIMT (chi(2) = 23.41, beta = 7.56, P = 0.004). Findings of the present study suggest that the BAC on mammography is independently associated with C-IMT. Screening mammographies merit to be evaluated for the presence of BAC, which might benefit cardiovascular preventive medicine in women by predicting atherosclerosis.

Association of paraoxonase activity and coronary collateral flow.

OBJECTIVES: Paraoxonase is a high-density lipoprotein-bound antioxidant enzyme that inhibits atherosclerosis and endothelial dysfunction. Coronary collateral flow is a crucial clinical entity with significant impact on the cardiovascular morbidity and mortality. This study sought to determine the relationship between the degree of angiographically visible coronary collateral circulation and serum paraoxonase activity. METHODS: The study population included 98 patients (mean age=57.9+/-10.1 years, 65 men) with angiographically documented total occlusion in one of the major coronary arteries. Development of collaterals was classified by Rentrop's method. Patients were defined as having poorly developed collaterals for Rentrop grades 0 and 1 or well-developed collaterals for Rentrop grades 2 and 3. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. RESULTS: Statistically significant differences between well and poorly developed collateral groups in respect to serum low-density lipoprotein cholesterol level (P=0.046), and serum paraoxonase (P=0.001), and arylesterase (P=0.014) activities were present. Serum low-density lipoprotein cholesterol level (chi=4.15, beta=-0.347, P=0.032) and serum paraoxonase activity (chi=10.43, beta=0.008, P=0.022) were independent predictors of well-developed coronary collateral flow. Serum paraoxonase activity gradually increased from collateral grade 0 to collateral grade 3 (analysis of variance P=0.003). Serum paraoxonase (r=0.362 and P<0.001) and arylesterase (r=0.245 and P=0.015) activities were both correlated with collateral flow grade. CONCLUSION: Findings of this study suggest that serum paraoxonase activity is independently associated with the degree of coronary collateral flow and reduced serum paraoxonase activity might represent a biochemical marker of impaired coronary collateral flow.

Lymphocyte DNA damage and total antioxidant status in patients with white-coat hypertension and sustained hypertension.

OBJECTIVES: We assessed lymphocyte DNA damage and total antioxidant status (TAS) in patients with white-coat hypertension (WCH) and sustained hypertension (SHT). STUDY DESIGN: The study included 23 patients (14 females, 9 males; mean age 46+/-6 years) with WCH, 21 patients (13 females, 8 males; mean age 45+/-7 years) with newly diagnosed SHT, and 19 age- and sex-matched healthy volunteers as controls. All subjects underwent echocardiographic examination, office blood pressure measurements, and 24-hour ambulatory blood pressure monitoring. DNA damage was assessed by the alkaline comet assay in peripheral lymphocytes, and plasma TAS levels were determined using an automated measurement method. RESULTS: The two hypertensive groups had similar echocardiographic measurements and office systolic and diastolic blood pressures. The mean daytime and nighttime pressures were significantly higher in the SHT group (p<0.05). Patients with WCH had similar daytime and nighttime pressures compared to the controls (p>0.05). Patients with SHT had significantly increased lymphocyte DNA damage (p<0.001, for both WCH and control groups) and decreased TAS level (p=0.012 vs WCH group; p<0.001 vs controls). Patients with WCH did not differ significantly from the control group with regard to lymphocyte DNA damage (p=0.052), but had significantly lower TAS levels (p<0.001). In the SHT group, lymphocyte DNA damage was correlated with TAS (r= -0.818, p<0.001), age (r=0.453, p=0.039), total cholesterol (r=0.550, p=0.010), and LDL-cholesterol (r=0.539, p=0.012). In multiple linear regression analysis, lymphocyte DNA damage was independently correlated with serum TAS level (beta= -0.717, p<0.001). In the WCH group, lymphocyte DNA damage was only correlated with serum TAS level (r= -0.458, p=0.028). CONCLUSION: Decreased TAS showing increased oxidative stress and increased lymphocyte DNA damage may contribute to target organ damage in patients with WCH.

Unruptured and ruptured sinus of Valsalva aneurysms in two cases.

Sinus of Valsalva aneurysms (SVA) are relatively rare lesions with a variable clinical presentation. We presented two patients, one of whom (male, aged 96 years) had an unruptured asymptomatic right SVA without a left-to-right shunt to the right ventricle, and the other (male, aged 33 years) a fistula from the right sinus of Valsalva to the right atrium due to nonpenetrating thoracic trauma. The diagnosis was made by echocardiography in both cases. The elderly patient was followed-up with medical therapy for a year without any complications. The younger patient had complaints of progressive exertional dyspnea and fatigue following blunt substernal and thoracic trauma. He underwent successful surgical repair of the SVA.