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INTRODUCTION: Carotid intima media thickness (CIMT), a direct marker of atherosclerosis, has emerged as a promising means for cardiovascular risk evaluation. Presystolic wave (PSW) is commonly detected by the Doppler interrogation of the left ventricular outflow tract (LVOT). It is thought to be a result of a stiff left ventricle and impaired LV compliance. Herein, we aimed to investigate a possible association between carotid intima media thickness, an atherosclerotic marker, and PSW. METHOD: We prospectively enrolled 282 patients divided into two groups based on the presence of PSW: 221 (89F; mean age: 49.3 ± 11.5 years) had PSW on Doppler examination while 61 patients (32F; mean age: 46.4 ± 10.3 years) did not. Both groups were compared with respect to demographic, clinical properties, and CIMT. RESULTS: Both groups had comparable age, body mass index, and diabetes mellitus, hypertension, dyslipidemia, smoking, and family history for coronary heart disease. PSW-positive group had significantly higher CIMT (PSW-positive: 0.59 ± 0.22 mm vs PSW-negative: 0.42 ± 0.11 mm; P < 0.001) than PSW-negative group. Multivariate analysis showed that the independent predictors of increased CIMT were age (95% CI; 1.044-1.101, P < 0.001), dyslipidemia (95% CI; 0.147-0.664, P = 0.002), and the presence of PSW (95% CI; 2.168-7.836, P < 0.001).Correlation analysis showed that PSW velocity is correlated with increased CIMT in PSW-positive group (r: 0.418, P < 0.001). CONCLUSION: Assessment of PSW on TTE is easy and feasible method. Presence of PSW and increased PSW velocity on TTE might provide information that we should be careful in terms of subclinical atherosclerosis.
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Aterosclerose/diagnóstico por imagem , Espessura Intima-Media Carotídea , Ecocardiografia Doppler/métodos , Ventrículos do Coração/diagnóstico por imagem , Aterosclerose/fisiopatologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: We aimed to investigate whether non-alcoholic fatty pancreas disease (NAFPD) is associated with epicardial adipose tissue (EAT), which is a kind of ectopic fat accumulation, and aortic intima-media thickness (aIMT), which is associated with subclinical atherosclerosis. METHODS: Fifty-four patients with NAFPD (22 men; mean age: 52 ± 10 years) and 49 without NAFPD (16 men; mean age: 49 ± 8 years) were included in this study. NAFPD and aIMT were evaluated using transabdominal ultrasonography (TUS). EAT was evaluated with transthoracic echocardiography. RESULTS: EAT (6.09 ± 1.52 mm and 3.87 ± 1.31 mm, p < 0.001) and aIMT [1.12 (0.60-1.90) mm vs. 0.93 (0.50-1.44) mm, p < 0.001] were significantly higher in the NAFPD positive subjects, compared to the NAFPD negative subjects. Multivariate analysis showed that age (p = 0.016), body mass index (p = 0.004), and presence of NAFPD (p = 0.024) were associated with increased aIMT. In addition, multivariate analysis demonstrated that the presence of NAFPD (p < 0.001) was associated with increased EAT. CONCLUSIONS: The presence of NAFPD on TUS is associated with increased aIMT and EAT. Our study results may suggest that NAFPD may reflect subclinical atherosclerosis and may be a simple warning sign for physicians.
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We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r = 0.495, p < 0.001). In multivariate regression analysis male sex (B = 0.169, p < 0.001, CI95% = 0.270-0.735), Log10 SYNTAX score (B = 0.282, p < 0.001, CI95% = 0.431-0.782), Log10 creatinine (B = 0.081, p = 0.036, CI95% = 0.043-1.239), low-density lipoprotein (B = 0.114, p = 0.003, CI95% = 0.001-0.006) and high-density lipoprotein (B = -0.360, p < 0.001, CI95% = -0.063 to -0.041) were the independent predictors of Trans Atlantic Inter-Society Consensus II class. We have shown that patients with complex peripheral artery disease had complex coronary artery disease.
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Doença da Artéria Coronariana/diagnóstico , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/diagnóstico , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Arterial Periférica/sangue , Doença Arterial Periférica/classificação , Doença Arterial Periférica/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients however data regarding left ventricle (LV) function in COPD is limited. We, in this study, aimed to evaluate the LV systolic function and its relation to BODE index in COPD patients with the utility of two-dimensional speckle tracking echocardiography (2D-STE). The study involved 125 COPD patients and 30 control subjects. All patients underwent 2D-echocardiography, pulmonary function tests and -minute walk tests. The patients were divided into four quartiles according to BODE index score. COPD patients had lower mitral annulus systolic velocity (Sm), average global longitudinal strain (GLS), average global longitudinal strain rate systolic (GLSRs), average GLSR early diastolic (GLSRe), average GLSR late diastolic (GLSRa), tricuspid annular plane systolic excursion (TAPSE) and peak systolic myocardial velocity (Sm-RV) (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p = 0.002 respectively) than control subjects. There were significant differences between BODE index quartiles in terms of Sm, average GLS and average GLSRs. Patients were divided into two groups according to median value of GLS (> -18.6 and ≤ -18.6). BODE index quartiles were found to be independent predictors of decreased GLS in multivariate logistic regression analysis (p = 0.030). Increased BODE index was associated with impaired LV mechanics in patients with COPD.
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Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Estudos Transversais , Ecocardiografia , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Sístole , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Capacidade VitalRESUMO
OBJECTIVE: The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). SUBJECTS AND METHODS: Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. RESULTS: The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore. CONCLUSION: The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD.
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Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Cefaleia/induzido quimicamente , Dinitrato de Isossorbida/análogos & derivados , Vasodilatadores/efeitos adversos , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Dinitrato de Isossorbida/administração & dosagem , Dinitrato de Isossorbida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Vasodilatadores/administração & dosagemRESUMO
OBJECTIVE: Severe pulmonary embolism (PE) has a high mortality rate, which can be lowered by thrombolytic therapy (TT). However, full-dose TT is associated with major complications, including life-threatening bleeding. The aim of this study was to explore the efficacy and safety of extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE. METHODS: This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE. RESULTS: The mean age of the patients was 68.76±14.54 years. The mean pulmonary artery systolic pressure (PASP; 56.51±7.34 mmHg vs. 34.16±2.81 mmHg, P<0.001) and right/left ventricle diameter (1.37±0.12 vs. 0.99±0.12, P<0.001) decreased significantly after TT. Tricuspid annular plane systolic excursion (1.43±0.33 cm vs. 2.07±0.27 cm, P<0.001), myocardial performance index (0.47±0.08 vs. 0.55±0.07, P<0.001), and systolic wave prime (9.6±2.8 vs. 15.3±2.6) increased significantly after TT. No major bleeding or stroke was observed. There was one in-hospital death and two additional deaths within 6 months. No cases of pulmonary hypertension were identified during follow-up. CONCLUSION: The results of this pilot study suggest that an extended infusion of low-dose tPA is a safe and effective therapy in patients with massive PE. This protocol was also effective in decreasing PASP and restoring right ventricular function.
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PURPOSE: The purpose of this study was to investigate the relationship between the Duke Treadmil Score (DTS) and coronary artery disease (CAD) complexity in patients with suspected coronary artery disease (CAD). METHODS: Sixty five patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed and Syntax score (SxScore), a marker of CAD complexity, was determined. The relationship between DTC and SxScore then evaluated. RESULTS: There was a strong negative correlation between DTS and SxScore (r = - 0.91, p < 0.001). In addition, patients with higher and intermediate risk as evaluated by DTS had increased SxScore compare to those that were low risk (23 ± 6, 6 ± 5 and 0 ± 0 respectively). CONCLUSIONS: A strong negative correlation was seen between DTS and coronary lesion complexity. By assessing DTS important information about coronary artery lesion complexity can be obtained before invasive coronary angiography.
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Doença da Artéria Coronariana/diagnóstico , Teste de Esforço/normas , Adulto , Idoso , Cardiologia/métodos , Cardiologia/normas , Angiografia Coronária/métodos , Doença das Coronárias/diagnóstico , Vasos Coronários/patologia , Eletrocardiografia/métodos , Teste de Esforço/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Risco , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
BACKGROUND AND OBJECTIVES: We aimed to investigate the effects of two different anesthetic techniques in our patients who underwent transcatheter aortic valve implantation (TAVI). METHODS: In this study, 303 patients who underwent TAVI procedure with a diagnosis of severe aortic stenosis between January 1, 2012 and December 31, 2018 were retrospectively evaluated. The patients were divided according to the type of anesthesia given during each procedure as; general anesthesia (GA), local anesthesia (LA). RESULTS: LA was preferred in 245 (80.8%) of 303 patients who underwent TAVI, while GA was preferred in 58 patients (19.1%). Median ages ââof our patients who received LA and GA were 83 and 84, respectively. The procedure and anesthesia durations of the patients in the GA group were longer than the LA group (p< 0.00001, p < 0.00001, respectively). Demographic and pre-operative clinical data were similar in comparison between two groups (p > 0.05) except for peripheral artery disease. Hypertension was the most common comorbidity in both groups. While the number of inotrope use was significantly higher in patients who received GA (p < 0.00001), no significant differences were found between LA and GA patients in terms of major complications and mortality (p > 0.05). Intensive care and hospital stays were significantly shorter in the LA group (p = 0.001, p = 0.023, respectively). CONCLUSION: The anesthetic technique of TAVI procedure did not have a significant effect on outcomes including; complications, mortality and success of the procedure. LA provides shorter duration of procedure and hospital stay.
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Anestésicos , Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Anestesia Geral , Anestesia Local , Estenose da Valva Aórtica/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Resultado do TratamentoRESUMO
This recent Turkish Myocardial Infarction registry reported that guidelines are largely implemented in patients with acute myocardial infarction (MI) in Turkey. We aimed to obtain up-to-date information for short- and midterm outcomes of acute MI. Fifty centers were selected using probability sampling, and all consecutive patients with acute MI admitted to these centers (between November 1 and 16, 2018) were enrolled. Among 1930 (mean age 62 ± 13 years, 26% female) patients, 1195 (62%) had non-ST segment elevation myocardial infarction (NSTEMI) and 735 (38%) had ST segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) was performed in 94.4% of patients with STEMI and 60.2% of those with NSTEMI. Periprocedural mortality occurred in 4 (0.3%) patients. In-hospital mortality was significantly higher in STEMI than in patients with NSTEMI (5.4% vs 2.9%, respectively; P = .006). However, the risk became slightly higher in the NSTEMI group at 1 year. Women with STEMI had a significantly higher in-hospital mortality compared with men (11.2% vs 3.8%; P < .001); this persisted at follow-up. In conclusion, PCI is performed in Turkey with a low risk of complications in patients with acute MI. Compared with a previous registry, in-hospital mortality decreased by 50% within 20 years; however, the risk remains too high for women with STEMI.
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Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Angiografia Coronária , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Sistema de Registros , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologiaRESUMO
BACKGROUND: New-onset atrial fibrillation (AF) is a frequent cause of presentation to the emergency department (ED). Epicardial fat thickness (EFT) is associated with the presence and recurrence of AF. However, no study has investigated the predictors of the time to conversion of AF to sinus rhythm with amiodarone therapy. The aim of this study was to investigate predictors of time to conversion of AF to sinus rhythm in patients with new-onset AF. METHODS: A total of 122 patients admitted to the ED with symptoms of hemodynamically stable new-onset AF (lasting <48 hours) were registered consecutively. These patients received intravenous amiodarone. EFT was measured using 2D echocardiography in parasternal long-axis views. RESULTS: A significant positive correlation was determined between EFT and conversion time (rho = 0.267, P = .017) in all patients. The median time for conversion from the start of amiodarone infusion was 410 min (150-830 minutes). Based on the median conversion time, patients were classified as early conversion (time < 410 minutes; n = 41) and late conversion (time > 410 minutes; n = 40). Multivariate logistic regression analysis demonstrated that EFT (P = .033, odds ratio [OR]: 1.68, 95% confidence interval [CI]: 1.6-2.7), higher troponin I level > 0.04 (P = .034, OR: 5.3, 95% CI: 1.1-24.8), and lower age (P = .003, OR: 0.8, 95% CI: 0.8-0.9) were significantly associated with longer conversion time. CONCLUSIONS: We determined that EFT and high troponin level affected the time to conversion to sinus rhythm in patients with new-onset AF.
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BACKGROUND: Despite improvements in treatment of ST-segment myocardial infarction (STEMI), thrombus formation in the left ventricle is still a concerning complication that may lead to systemic thromboembolism and stroke. OBJECTIVES: To evaluate the predictive value of estimated whole blood viscosity (WBV) for left ventricular thrombus development in patients surviving an acute anterior myocardial infarction (AAMI).MATERIALS \& METHODS:Seven hundred eighty AAMI patients who were treated percutaneously were enrolled consecutively. Serial echocardiographic examinations were performed within 24h of admission, before hospital discharge, and at 1, 3, 6 and 12 months following hospital discharge. WBV was calculated according to de Simones formula. RESULTS: One hundred patients (12.8%) developed thrombus formation within one year following AAMI. Patients with left ventricular thrombus (LVT) had significantly higher WBV values. Supramedian values of WBV at both low (0.5 sec-1) and high (208 sec-1) shear rates were found to be an independent predictor of LVT development. CONCLUSION: As an easily accessible parameter, WBV might be a useful predictor of LVT formation within one year following acute anterior myocardial infarction.
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Infarto Miocárdico de Parede Anterior , Viscosidade Sanguínea , Infarto do Miocárdio , Trombose , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Ecocardiografia , Humanos , Infarto do Miocárdio/diagnóstico por imagem , Trombose/diagnóstico por imagemRESUMO
The main aim of this study was to investigate the relation between anterior tragal crease (ATC) and coronary artery lesion complexity and severity assessed using the SYNTAX score (SXscore) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total of 121 patients with a first-time diagnosis of NSTEMI were consecutively enrolled. ATC was defined as ≥1 crease that was close to the tragus and descended anteriorly. SXscore was calculated using the SXscore algorithm. The SXscore was higher in the ATC-positive group than in the ATC-negative group (11.85 ± 8.20 vs 7.52 ± 6.38, P = .003). In the univariate analysis, hemoglobin (male: 11.7-17.4 g/dL, female: 11.7-16.1 g/dL; P = .006), diabetes mellitus (P = .031), current smoking (P = .022), and presence of ATC (P = .022) were significantly associated with increased SXscore. Multivariate analysis revealed ATC (95% confidence interval [CI]: 1.313-7.800, P = .011), current smoking (95% CI: 2.034-13.893, P = .001), and hemoglobin (95% CI: 0.433-0.822, P = .002) as independent determinants of increased SXscore. Anterior tragal crease is easily detected by physical examination. Presence of ATC in patients with NSTEMI may be a warning signal of complexity and severity of coronary artery disease (CAD).
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Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Pavilhão Auricular , Pescoço , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Envelhecimento da Pele , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Exame Físico , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Since aortic valve sclerosis (AVS) and coronary artery disease (CAD) share similar cardiovascular risk factors, we hypothesized that the clinical profile of patients with acute myocardial infarction (AMI) would be worse in the presence of AVS. The aim of this study was to investigate the association between AVS and clinical factors in patients with AMI. METHODS: Three hundred and fifteen patients with AMI were consecutively enrolled in the study. Echocardiography was used to assess the aortic valve morphology and left ventricular function. The extent and severity of CAD were assessed by Gensini score and the number of obstructed vessels. The patients were divided into 2 groups according to presence or absence of AVS. RESULTS: The overall number of patients with AVS was 132 (41.9%). Patients with AVS were older (69.5 ± 11 vs. 59.5 ± 12 years, P < 0.00001). They also had a higher prevalence of hypertension (61% vs. 45%, Pâ¯=â¯0.006), prior CAD (33% vs. 23%, Pâ¯=â¯0.041), prior AMI (20% vs. 11%, Pâ¯=â¯0.019) and a higher percentage were female (32% vs. 19%, Pâ¯=â¯0.007) compared with AMI patients without AVS. There was no significant difference between the 2 groups with respect to the Gensini score (Pâ¯=â¯0.372). Prior AMI was associated with AVS on age-adjusted logistic regression analyses. A multivariate analysis showed an independent association between the AVS and prior AMI and age (P < 0.0000001, Pâ¯=â¯0.022, respectively). CONCLUSIONS: Our results showed that the presence of AVS is associated with AMI recurrence.
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Estenose da Valva Aórtica/complicações , Infarto do Miocárdio/complicações , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Recidiva , Turquia/epidemiologiaRESUMO
BACKGROUND: Myocardial performance index (MPI), demonstrates both systolic and diastolic functions of the left ventricle. Presystolic wave (PSW) is frequently detected on Doppler examination of the left ventricular outflow tract and possible mechanism of PSW is impaired LV compliance and left ventricular stiffness. OBJECTIVE: To investigate the relationship between PSW and MPI in type 2 diabetic patients. METHOD: A total of 129 type 2 diabetic patients were included in this study. Patients were divided into two groups according to the presence of PSW on Doppler echocardiography. There were 90 patients (38 male, mean age 57.77 ± 10.91 years) in the PSW-positive group and 39 patients (13 male; mean age: 55.31 ± 11.29 years) in the PSW-negative group. The p values of < 0.05 were considered statistically significant. RESULTS: MPI was higher in PSW- positive group (0.63 ± 0.17vs 0.52 ± 0.13, p < 0.001). In addition, subclinical left ventricle dysfunction (LVD) was higher in the PSW- positive group (p = 0.029). Univariate analysis showed that the presence of PSW associated with abnormal MPI (p = 0.031). Pearson correlation analysis showed that PSW velocity correlated with MPI (r: 0.286, p = 0.006). CONCLUSION: Presence of the PSW on Doppler examination was associated with subclinical LV dysfunction in patients with DM type 2. This easy-to-perform echocardiographic parameter may be related to subclinical LVD among patients with type 2 DM.
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Diabetes Mellitus Tipo 2/fisiopatologia , Ecocardiografia Doppler/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Adulto , Idoso , Índice de Massa Corporal , Estudos Transversais , Feminino , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores de Risco , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologiaRESUMO
BACKGROUND: There are few reports demonstrating a relationship between presystolic wave (PSW) and left ventricular function. The aim of the present study was to investigate the associations between PSW and angiographic and echocardiographic characteristics of patients with acute myocardial infarction (AMI). METHODS: We studied 348 consecutive patients with AMI. Pulsed Doppler-echocardiography was used to assess the both diastolic functions and presence of PSW from left ventricular outflow tract. Patients were divided into two groups by the presence or absence of PSW. The Syntax score (SXscore) was calculated from baseline angiograms to assess the complexity and severity of coronary artery disease. RESULTS: The overall prevalence of PSW was 51.1%. Compared to patients without PSW, patients with PSW presence had greater left ventricular ejection fraction (LVEF), greater septal a' velocity, lower mitral E and septal e' velocity and lower E/A and e'/a' ratios. Also, median SXscore were significantly lower in the PSW presence group compared to PSW absence group [1 (6-14) vs. 12 (7-18), P = 0.013]. In addition, the number of patients with high-SXscore (> 16) was significantly lower in PSW presence group (24 vs. 42), (P = 0.006). In multiple logistic regression analysis, absence of PSW found independent predictor of high-SXscore (OR 2.297 95% CI 1.235-4.272; P = 0.009). CONCLUSIONS: We found that the presence of PSW was related with higher LVEF, lower SXscore and lower stage diastolic dysfunction in patients with AMI. PSW may be used in prediction of the coronary artery disease complexity and it could help risk stratification in patients with AMI.
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Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Ecocardiografia Doppler de Pulso , Hemodinâmica , Infarto do Miocárdio/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/fisiopatologia , Razão de Chances , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico , Calcificação Vascular/fisiopatologiaRESUMO
Potassium (K) concentration plays a significant role in cell metabolism and membrane excitability. The imbalance of serum potassium is important because it can lead to life-threatening events. Potassium balance may be lost both through the neurohormonal mechanisms involved in cardiovascular diseases and through the drugs used in the treatment of this illness. Avoiding both hypo- and hyperkalemia is beneficial in several cardiovascular diseases, especially heart failure. Electrolyte abnormalities are frequently seen complications in subjects with heart failure. Malignant ventricular arrhythmias and sudden cardiac death are particularly feared complications in K+ instability.
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Insuficiência Cardíaca/sangue , Homeostase , Potássio/sangue , Adenosina Trifosfatases/sangue , Adenosina Trifosfatases/efeitos dos fármacos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Biomarcadores/sangue , Glicosídeos Cardíacos/efeitos adversos , Fibrinolíticos/efeitos adversos , Insuficiência Cardíaca/fisiopatologia , Heparina/efeitos adversos , Homeostase/efeitos dos fármacos , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/induzido quimicamente , Hipopotassemia/sangue , Hipopotassemia/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Bloqueadores dos Canais de Sódio/efeitos adversosRESUMO
Myocardial bridging is one of the nonatherosclerotic causes of coronary artery disease and is characterized by muscles overlying the intramyocardial course of a major epicardial coronary artery segment, leading to systolic compression. Myocardial bridging is considered a benign condition in most cases, but has been associated with serious cardiac events such as myocardial infarction and sudden death. We discuss the case of a 63-year-old man who was admitted to our hospital with effort-induced angina, bradycardia, and left ventricular hypertrophy on electrocardiogram. On coronary angiography, we found significant myocardial bridging with total occlusion in the left anterior descending artery during systole. In patients with myocardial bridging, symptoms often manifest during exercise and with tachycardia. But it is interesting to note that our patient was bradycardic and became symptomatic with minimal effort. Thus, we thought that these emphasized its significance and affected treatment strategy.
Assuntos
Cardiomiopatias/cirurgia , Ponte de Artéria Coronária , Angina Pectoris/etiologia , Bradicardia/etiologia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/etiologia , Estenose Coronária/cirurgia , Ecocardiografia , Eletrocardiografia , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Stiffness of large arteries has been related to cardiovascular mortality. The cardioankle vascular index (CAVI) is a novel parameter of arterial stiffness. The main aim of the present study was to investigate the association between presystolic wave (PSW) on left ventricular outflow tract (LVOT) and CAVI. PATIENTS AND METHODS: Patients admitted to the cardiology outpatient clinic were consecutively enrolled. Arterial stiffness was assessed by the CAVI. It was measured using a VaSera VS-1000 CAVI instrument. Pulse Doppler flow evaluation in LVOT was performed just proximal to the aortic valve in an apical five-chamber view. The presence of a PSW preceding the LVOT flow was assessed in all patients. RESULTS: A total of 200 patients were enrolled consecutively. Patients with PSW had higher CAVI values compared with those without PSW (8.6±1.6 vs. 7.3±1.5). There was a significant correlation between PSW velocity and CAVI (r=0.34, P<0.001). Analysis using the receiver operating characteristics curve showed that PSW velocity of 61 cm/s constitutes the cutoff value for abnormal CAVI (CAVI≥9) with 75% sensitivity and 74% specificity (area under the curve: 0.883, 95% confidence interval: 0.694-0.972). CONCLUSION: Assessment of presystolic A wave on echocardiography examination may provide important information on the vascular function, which has a prognostic impact.
Assuntos
Ecocardiografia , Análise de Onda de Pulso , Rigidez Vascular , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Detection of increased arterial stiffness could prevent patients from being mistakenly classified as being at a low or a moderate risk, when they actually are at a high risk. The main aim of present study was to investigate the relation between fragmented QRS (fQRS) on ECG and the cardio-ankle vascular index (CAVI), which is a novel parameter of arterial stiffness in asymptomatic hypertensive patients. METHODS AND RESULTS: Seventy-five asymptomatic hypertensive patients with fQRS and 75 age-matched and sex-matched control individuals without fQRS were enrolled. Patients with fQRS had higher CAVI values compared with those without fQRS (8.6 ± 1.4 vs. 7.9 ± 1.3, P=0.01). In univariate analyses, there was a significant association between increased CAVI and age (P<0.001) and fQRS (P=0.003). Multivariate binary logistic regression analyses showed fQRS (95% confidence interval: 0.122-0.675, P=0.004) and age (95% confidence interval: 1.022-1.105, P=0.002) as the independent determinants of increased CAVI. The sensitivity and specificity of fQRS for predicting abnormal CAVI were 55 and 76%, respectively. CONCLUSION: The presence of fQRS on ECG may provide important predictive information on arterial stiffness in asymptomatic hypertensive patients.
Assuntos
Índice Tornozelo-Braço , Vasos Coronários/patologia , Eletrocardiografia , Hipertensão/fisiopatologia , Rigidez Vascular , Doenças Assintomáticas , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Oxidative stress plays a major role in the development of atherosclerosis. However, the relationship between oxidative stress and complexity and intensity of coronary artery disease is less clear. The aim of this study is to assess the relationship between oxidative stress markers and the complexity and intensity of coronary artery disease in patients with acute coronary syndrome (ACS). METHODS: Sixty-seven consecutive patients with an early phase of ACS (<3 h) were included in this single-centre, cross-sectional, prospective study. Syntax and Gensini scores were calculated based on angiographic findings. Patients were divided into two CAD complexity groups according to their Syntax scores: low SYNTAX score (<22) and moderate to high SYNTAX score (>=22). Likewise patients were divided into two CAD severity groups according to the median Gensini score of 64: less intensive CAD with Gensini score (<64) and intensive CAD with Gensini score >=64. Blood samples were taken in 1 hour within administration in order to measure total oxidative status (TOS) and total antioxidant capacity (TAC) levels determined by Erel method. Oxidative stress index (OSI) was calculated by TOS /TAC. RESULTS: There was no significant difference between the two SYNTAX groups for oxidative stress markers. Median TOS and OSI values were significantly high in the intensive CAD group (p=0.005, p=0.04, respectively). The Gensini score was positively correlated with TOS and OSI (p=0.003, p=0.02, respectively). CONCLUSION: Oxidative stress markers may be considered supportive laboratory parameters related to CAD intensity but not complexity in ACS patients.