The Relationship Between Clinical Outcomes and Calculated Thrombus Burden Before and After Initial Flow in Patients with ST-Segment Elevation Myocardial Infarction.

OBJECTIVE: Primary percutaneous coronary intervention is the standard treatment for ST-segment eleva- tion myocardial infarction. Although myocardial and epicardial perfusion is usually achieved with primary percutaneous coronary intervention, infarct-related arterial thrombus burden negatively affects the proce- dural success and clinical outcomes of primary percutaneous coronary intervention. Therefore, we aimed to investigate the association between thrombus burden (calculated before and after initial flow) and clinical consequences in patients with ST-segment elevation myocardial infarction. MATERIALS AND METHODS: This study retrospectively enrolled 1376 patients who had ST-segment elevation myo- cardial infarction between May 2012 and November 2015. Patients who had only undergone balloon angio- plasty and emergency coronary artery bypass grafting were not included in the study. Data regarding the initial clinical and demographic features of the patients were obtained from their hospital records. Thrombus burden was calculated using baseline and final (after wire inflation or small balloon dilatation) thrombolysis in myocardial infarction thrombus grades. The endpoints of the study were defined as no-reflow development after primary percutaneous coronary intervention and 1-year all-cause mortality. Statistical significance was defined as P < .05. RESULTS: No-reflow was detected in 169 patients (12.3%). The calculated basal thrombus burden was signifi- cantly associated with post-procedural no-reflow (P < .001). No-reflow was also associated with advanced age (P < .001), longer pain-to-door time (P < .001), and increased blood glucose levels (P = .032). The calcu- lated final thrombus burden was related to 1-year all-cause mortality (P = .047). One-year all-cause mortality was also associated with advanced age (P < .001), high Killip scores (P=.003), increased white blood cell counts (P = .001), and low estimated glomerular filtration rates (P < .001). CONCLUSION: Basal thrombus burden was associated with no-reflow, and final thrombus burden was associ- ated with 1-year all-cause mortality. The calculation of thrombus burden before and after initial flow may help to predict clinical outcomes.

Evaluation and Comparison of Left Ventricular Functions by Cardiac MRI and 2D Transthoracic Echocardiography.

OBJECTIVE: It is important to measure left ventricular function (LVF) accurately in the diagnosis and follow-up of cardiovascular diseases. Different imaging algorithms and mathematical calculations have been developed for the evaluation of LVF in cardiac magnetic resonance imaging (MRI), and numerous studies are still being carried on this. In our study, LVF was calculated by two different measurement methods in MRI and were compared with transthoracic echocardiography (TTE) to assess the correlation and the consistency of these with TTE. MATERIALS AND METHODS: In this study, 31 patients with left ventricular dysfunction due to different etiologies were evaluated with simultaneous TTE and MRI. In the Cine MR images, LVF parameters of ejection fraction, end-diastolic volume, end-systolic volume, and myocardial mass were measured using short axis images (short axis method) and short axis plus four chamber and two chamber images (combined method). The results were compared with the results from TTE. RESULTS: We found that the combined and the short axis-based calculations of ejection fraction, end-diastolic volume, end-systolic volume, and myocardial mass in cardiac MRI showed correlation and consistency with those calculated via echocardiography. We also determined that the short axis-based calculations in cardiac MRI showed better correlation with the echocardiography compared with the combined method. CONCLUSION: Because our results revealed that the cardiac MRI results obtained from the short axis method better correlate with the TTE, we recommend using short axis-based measurements in the evaluation left ventricular dysfunction.

Serum metabolite profiling of ST-segment elevation myocardial infarction using liquid chromatography quadrupole time-of-flight mass spectrometry.

ST segment elevation myocardial infarction (STEMI) is one of the most common global causes of cardiovascular disease-related death. Several metabolites may change during STEMI. Hence, analysis of metabolites in body fluid may be considered as a rapid and accurate test for initial diagnosis. This study has therefore attempted to determine the variation in metabolites identified in the serum of STEMI patients (n = 20) and 15 controls. Samples collected from the Cardiology Department, Medical Faculty, Ataturk University, were extracted by liquid-liquid extraction and analysed using liquid chromatography quadrupole time-of-flight mass spectrometry. The METLIN database was used for the identification and characterization of metabolites. According to Q-TOF/MS measurements, 231 m/z values, which were significantly different between groups (P < 0.01 and fold analysis >1.5) were detected. Metabolite identification was achieved via the Human Metabolome database. According to the multivariate data analysis, leucine, isoleucine, l-proline, l-alanine, glycine, fumaric acid, citrate, succinate and carnitine levels were decreased, whereas levels of propionic acid, maleic acid, butyric acid, urea, oleic acid, palmitic acid, lysoPC [18:2(9Z)], glycerol, phoshpatidylethanolamine, caffeine and l-lactic acid were increased in STEMI patients compared with controls. In conclusion, malonic acid, maleic acid, fumaric acid and palmitic acid can be used as biomarkers for early risk stratification of patients with STEMI.

microRNAs Expression as Novel Genetic Biomarker for Early Prediction and Continuous Monitoring in Pulmonary Cancer.

One of the main causes of death in the world is lung cancer. According to the World Health Organization, the annual incidence of lung cancer increases significantly. Moreover, lung cancer accounts for one of the highest mortality rates, mainly due to late detection. Numerous studies have been conducted in order to identify new biomarkers for early diagnosis and for monitoring and evaluation of lung cancer stages. An ideal biomarker candidate is represented by the analysis of microRNAs expression. In this paper, we want to summarize microRNAs expressions in lung cancer. We also want to present the expression of microRNAs depending on the evolution of lung cancer. For this study, we analyzed the studies available in scientific databases, such as PubMed and Scopus. The studies were selected using the search keywords "microRNAs expression," "lung cancer," and "genetic biomarkers." The most significant articles were selected for the study, following rigorous analysis. To evaluate and monitor lung cancer, the expression of microRNAs may be used successfully due to increased specificity and selectivity. However, further studies are needed on the assignment and validation of microRNAs for each type of lung cancer, respectively, for each stage of evolution.

Early Evaluation and Monitoring of Critical Patients with Acute Respiratory Distress Syndrome (ARDS) Using Specific Genetic Polymorphisms.

A high percentage of critical patients are found to develop acute respiratory distress syndrome (ARDS). Several studies have reported high mortality rates in these cases which are most frequently associated with multiple organ dysfunctions syndrome. Lately, many efforts have been made to evaluate and monitor ARDS in critical patients. In this regard, the assessment of genetic polymorphisms responsible for developing ARDS present as a challenge and are considered future biomarkers. Early detection of the specific polymorphic gene responsible for ARDS in critically ill patients can prove to be a useful tool in the future, able to help decrease the mortality rates in these cases. Moreover, identifying the genetic polymorphism in these patients can help in the implementation of a personalized intensive therapy scheme for every type of patient, based on its genotype.

Ventricular Tacyhcardia in A Patient with A Previous History of Endocarditis and Ankylosan Spondylitis: A Challenging Case.

Cardiac conduction defects are commonly observed in patients with ankylosing spondylitis, infective endocarditis, and aortic valve replacement. Each of these clinical situations can also present with ventricular tacyhcardia by different mechanisms. Here we report the case of a 53-year-old man with a medical history of untreated ankylosing spondylitis and aortic valve replacement who presented with ventricular tachycardia and underwent successful catheter ablation. Most ventricular tachycardia episodes were intermittent and drug resistant, which could have been caused by abnormal automaticity rather than re-entry.

Corrected balloon occlusive diameter to determine device size during percutaneous atrial septal defect closure.

OBJECTIVE: The aim of this trial was to investigate the impact of corrected balloon occlusive diameter (cBOD) on successful performance of percutaneous atrial septal defect (ASD) closure. METHODS: The trial comprised 86 patients (60 female, 26 male; mean age 36.5±14.3) on whom percutaneous ASD closure was performed. Patients were evaluated using transesophageal echocardiography (TEE). Relation of the defect to surrounding tissues and size of rims was also investigated. Balloon sizing was performed intraoperatively on all patients. Size of device was ascertained according to both durability of rims and whether or not they formed significant indentation, both of which determine cBOD. RESULTS: The ASD closure device was successfully implanted in 84 (97.5%) patients. Mean maximum defect size was 17.4±5.9 mm, and mean color flow diameter was 16.8±5.4 mm. Mean maximum defect size at the moment of loss of shunt flow was 18.4±5.9 mm with TEE, and 18.8±6.1 mm with fluoroscopy. Mean size of Amplatzer occluder device was 20.0±6.5 mm. Device embolization was observed in 2 patients. However, no death occurred during or after the procedure. CONCLUSION: Percutaneous secundum ASD closure is a safe and effective treatment modality in experienced centers. Utilizing corrected balloon occlusive diameter may be of benefit in deciding the size of ASD occluder device.

The correlation of ECHO findings of right cardiac pathologies with BNP, uric acid, and CRP in OSAS.

BACKGROUND/AIM: Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS. MATERIALS AND METHODS: A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients. RESULTS: Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions. CONCLUSION: BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.

Acute effect of primary percutaneous coronary intervention on left ventricular dyssynchrony in ST-segment elevation myocardial infarction.

OBJECTIVE: The aim of this study was to prospectively evaluate the effect of percutaneous coronary intervention in the acute period on left ventricular dyssynchrony in ST-segment elevation myocardial infarction patients by using Tissue Synchronization Imaging. METHODS: Forty-four ST-segment elevation myocardial infarction (MI) patients (29 male, 15 female), who were admitted within the first 12 hours of chest pain symptoms, were enrolled in the study. According to the localization of MI, the patients were divided into groups as anterior MI (n=26) and inferior MI (n=18). All echocardiography measurements were taken just before percutaneous coronary intervention (PCI) and following PCI at a mean of 3-6 days. They were assessed according to the time to reach the peak systolic velocity, which was calculated by the tissue synchronization imaging method from four pairs of non-apical alternate segments. The difference between the duration to reach the peak systolic velocity in alternate segments was regarded as left ventricle dyssynchrony and the results were compared. RESULTS: In the anterior MI group, basal anterior (p<0.01), mid-anterior segment (p<0.01) and basal septal segment (p<0.01); in the inferior MI group, the basal septal segment (p=0.02), mid-septal segment (p=0.02), and basal and mid-inferior segment (p<0.01) values were significantly lower in the post-PCI measurements when compared to the measurements taken prior to PCI. In both groups, the intraventricular dyssynchrony indices of the basal anterior-basal inferior (p<0.01), mid-anterior-mid-inferior (p<0.01) segments were found to be significantly lower in the post-PCI period when compared to the pre-PCI period. CONCLUSION: It was found that percutaneous coronary intervention in patients with ST-elevation significantly decreases the degree of LV dyssynchrony in the acute period.

Follow-up of coronary artery bypass graft patency: diagnostic efficiency of high-pitch dual-source 256-slice MDCT findings.

OBJECTIVES: Our aim was to evaluate the diagnostic accuracy of 256-slice, high-pitch mode multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. METHODS: Eighty-eight patients underwent 256-slice MDCT angiography to evaluate their graft patency after CABG surgery using a prospectively synchronized electrocardiogram in the high-pitch spiral acquisition mode. Effective radiation doses were calculated. We investigated the diagnostic accuracy of high-pitch, low-dose, prospective, electrocardiogram-triggering, dual-source MDCT for CABG patency compared with catheter coronary angiography imaging findings. RESULTS: A total of 215 grafts and 645 vessel segments were analyzed. All graft segments had diagnostic image quality. The proximal and middle graft segments had significantly (P < 0.05) better mean image quality scores (1.18 ± 0.4) than the distal segments (1.31 ± 0.5). Using catheter coronary angiography as the reference standard, high-pitch MDCT had the following sensitivity, specificity, positive predictive value, and negative predictive value of per-segment analysis for detecting graft patency: 97.1%, 99.6%, 94.4%, and 99.8%, respectively. CONCLUSIONS: In conclusion, MDCT can be used noninvasively with a lower radiation dose for the assessment of restenosis in CABG patients.

Comparison of carotid artery stenting and carotid endarterectomy in patients with symptomatic carotid artery stenosis: a single center study.

INTRODUCTION: Carotid artery stenting (CAS) is believed to be an alternative to carotid endarterectomy (CEA); however, recent studies have demonstrated an increase of complications with stenting that does not reflect our experience. We thus wanted to compare the periprocedural and 1-year follow-up outcomes of CAS with those of CEA among patients with symptomatic extracranial carotid stenosis in a population from eastern Turkey. METHODS: The hospital records of all patients who underwent carotid artery revascularization were retrospectively reviewed. Patients were divided into two groups based on the type of carotid revascularization performed, namely CEA or CAS. Comparisons were made with respect to 30-day and 1-year outcomes of transient ischemic attack (TIA), myocardial infarction (MI), stroke, and all-cause death rates. Composite endpoints for both groups were also analyzed. RESULTS: Thirty-two CEA and 33 CAS procedures were performed for symptomatic occlusive carotid disease. Baseline characteristics were similar between both groups except for the incidence of diabetes mellitus. No significant differences were found with respect to 30-day mortality, MI, and neurologic morbidity endpoints for CEA and CAS procedures. In the postprocedural 1-year follow-up, only TIA was observed to be significantly higher in the CAS group; the other endpoints did not differ significantly. One-year composite endpoints did not differ between both groups (log-rank P = 0.300). CONCLUSION: In our trial of patients with symptomatic carotid artery stenosis, no significant difference could be shown in periprocedural outcomes, postprocedural outcomes except TIA, and in composite endpoints between the CEA and CAS groups. CAS is a safe and efficacious alternative for the treatment of symptomatic carotid artery stenosis.

The Impact of Trimetazidine Treatment on Left Ventricular Functions and Plasma Brain Natriuretic Peptide Levels in Patients with Non-ST Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the impact of treatment with oral trimetazidine (TMZ) applied before and after percutaneous coronary interventions (PCI) on short-term left ventricular functions and plasma brain natriuretic peptide (BNP) levels in patients with non-ST segment elevation myocardial infarction (NSTEMI) undergoing PCI. SUBJECTS AND METHODS: The study included 45 patients who were undergoing PCI with the diagnosis of NSTEMI. The patients were randomized into two groups. The first group (n=22) of the patients hospitalized with the diagnosis of NSTEMI was given conventional therapy plus 60 mg TMZ just prior to PCI. Treatment with TMZ was continued for one month after the procedure. TMZ treatment was not given to the second group (n=23). Echocardiography images were recorded and plasma BNP levels were measured just prior to the PCI and on the 1st and 30th days after PCI. RESULTS: The myocardial performance index (MPI) was greater in the second group (p=0.02). In the comparison of BNP levels, they significantly decreased in both of the groups during the 30-day follow-up period (29.0±8 and 50.6±33, p<0.01 respectively). However, decreasing of BNP levels was higher in the group administered with TMZ. The decrease of left ventriclular end-diastolic volume was observed in all groups at 30 days after intervention, but was higher in the group administered with TMZ (p=0.01). CONCLUSION: Trimetazidine treatment commencing prior to PCI and continued after PCI in patients with NSTEMI provides improvements in MPI, left ventricular end diastolic volume and a decrease in BNP levels.

Assesment of myocardial ischemia by combination of tissue synchronisation imaging and dobutamine stress echocardiography.

BACKGROUND AND OBJECTIVES: Dobutamine stress echocardiography (DSE) is an important non-invasive imaging method for evaluating ischemia. However, wall motion interpretation can be impaired by the experience level of the interpreter and the subjectivity of the visual assessment. In our study we aimed to combine DSE and tissue syncronisation imaging to increase sensitivity for detecting ischemia. SUBJECTS AND METHODS: 50 patients with indications for DSE were included in the study. In 25 patients we found DSE positive for ischemia and in the other 25 patients we found it to be negative. The negative group was accepted as the control group. There was no significant difference in terms of risk factors and echocardiographic parameters between the two groups, except for wall motion scores. In both groups, left ventricular dyssychrony was accepted as the difference between time to peak systolic velocity (Ts) in the reciprocal four couple of non-apical segments at rest and during peak stress. Timings were corrected for heart rate. We compared the differences of the dyssynchronisation value at rest and during peak stress to determine the distinctions within the groups and between the groups of DSE positive and negative patients. RESULTS: We found that stress and ischemia did not create any significant difference over the left intraventricular dyssynchrony with DSE, although at the segmenter level it prolonged the time to peak systolic velocity (p<0.05). These alterations did not show any significant difference between positive and negative DSE groups. CONCLUSION: As a result, this segmenter dyssynchrony and the time to peak systolic velocity, which is corrected for heart rate, did not enhance any new value over DSE for detecting ischemia.

Speckle tracking echocardiographic analysis of left ventricular systolic and diastolic functions of young elite athletes with eccentric and concentric type of cardiac remodeling.

AIMS: In individuals who exercise regularly and for extended periods of time, some structural alterations in the heart, called the athlete's heart, develop in time. These alterations vary in type, can be eccentric or concentric, depending on the nature of exercise. Speckle tracking echocardiography (STE) is a novel, angle-independent method that accurately and reliably measures systolic and diastolic functions of the left ventricle (LV) with considerably lower inter-operator variability. METHODS AND RESULTS: Twenty-two marathon runners, 24 wrestlers, and 20 healthy sedentary individuals were included in the study. The average age of subjects is 17.5 ± 2.2 in marathon runners, 16.8 ± 1.9 in wrestlers, and 16.4 ± 1.8 in control group. The parameters of LV longitudinal strain (S), LV longitudinal strain rate systolic (SRS), LV longitudinal strain rate diastolic early filling (SRE), and longitudinal strain rate diastolic late filling (SRA) were evaluated by apical two-, three-, and four-chamber grayscale imaging using the global longitudinal strain (GLS) and GLS rate (GLSR). Conventional echocardiographic parameters demonstrated increased LV diameters and wall thickness in the marathon runners and increased wall thickness without increased LV diameters in the wrestlers. Systolic and diastolic functions were comparable between the marathon runners and wrestlers with conventional echocardiography. Analysis with STE, however, yielded higher systolic strain and strain rates in the athletes. Normalized GLS parameters and end-diastolic volume (EDV) were shown to be correlated. CONCLUSION: Overall, conventional echocardiography can detect some differences between young athletes with eccentric and concentric type of athlete's heart but it is incapable of revealing differences in intrinsic myocardial functions. However, analysis using STE demonstrated increased systolic functions in athletes commensurate with increased load, with unaltered diastolic functions.

Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture.

UNLABELLED: Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. KEY WORDS: Chest pain; Coronary artery disease; Esophageal rupture; Misdiagnosis.

Efficacy of ivabradin to reduce heart rate prior to coronary CT angiography: comparison with beta-blocker.

PURPOSE: The objective of our study was to assess the effect of ivabradine on image quality of ECG-gated multidetector computed tomography (MDCT) coronary angiography. MATERIALS AND METHODS: Computed tomography coronary angiography (CTCA) was performed on two groups. In Group 1 (n=54), an intravenous beta-blocker was administered to patients with a heart rate >70 beats per minute (bpm) just before CTCA. In Group 2 (n=56), oral ivabradine 5 mg was administered twice a day for three days prior to CTCA examination to patients with a heart rate >70 bpm and contraindication to beta-blockers. Images acquired on two different MDCT scanners were scored in terms of image quality of the coronary artery segments using a 5-point grading scale (Grade 1, unreadable; Grade 5, excellent). RESULTS: The mean heart rates during CTCA were 64 ± 6.7 bpm for Group 1 and 59 ± 4.1 bpm for Group 2 (P < 0.05). Mean heart rate reduction was 9 ± 5% and 14 ± 8% for Groups 1 and 2, respectively (P < 0.001). A total of 880 segments were evaluated in 110 patients. When the best reconstruction interval was used, 89.8% and 95.5% of all the coronary segments showed acceptable image quality in Groups 1 and 2, respectively. Acceptable image quality of the middle right coronary artery was obtained in 78.3% of Group 1 and 92.4% of Group 2. These ratios for the other segments were 88.4% for Group 1 and 95.2% for Group 2. CONCLUSION: Reduction of heart rates with ivabradine premedication improves the image quality of CTCA. It should be considered as an alternative drug, particularly in patients with contraindications to beta-blockers.

Can left atrial strain and strain rate imaging be used to assess left atrial appendage function?

BACKGROUND: The aim of this study was to evaluate the efficiency of left atrial strain (S) and strain rate (SR) imaging in assessing left atrial appendage (LAA) function. METHODS: We studied 78 consecutive patients (35 females and 43 males; mean age 38 ± 15 years) referred for transesophageal echocardiography (TEE). LAA late emptying velocity (LAA-EV) was calculated. Real-time color Doppler myocardial velocity imaging (MVI) data were recorded from the LAA by TEE and the lateral wall of the left atrium (LA) by transthoracic echocardiography. Longitudinal S and SR were measured in the mid portion of the lateral LA wall and lateral LAA wall during the contractile period. LAA late systolic velocity (LSV) and LA-LSV were obtained from Doppler analysis. RESULTS: A significant positive correlation was detected between LAA-EV and MVI parameters (for LAA-S, r = 0.88, p < 0.001; for LAA-SR, r = 0.84, p < 0.001; for LAA-LSV, r = 0.83, p < 0.001; for LA-S, r = 0.84, p < 0.001; for LA-SR, r = 0.79, p < 0.001, and for LA-LSV, r = 0.70, p < 0.001). In addition, a significant positive correlation was detected between LAA-S and LA-S (r = 0.85, p < 0.001). CONCLUSION: We suggest that LA-S and LA-SR imaging is a beneficial method to evaluate LAA functions noninvasively.