Is the revascularisation strategy and outcome different in patients with acute coronary syndrome in COVID-19 pandemic era: a tertiary centre experience.

BACKGROUND: In this study, we aimed to compare the management and clinical outcomes of patients with acute coronary syndrome (ACS) before and during pandemic. METHODS: A total of 239 patients with ACS were enrolled into the study. Patients who were admitted during pandemic were compared with pre-pandemic patients according to their demographic, biochemical, angiographic features, revascularisation strategies and clinical outcomes. RESULTS: During the pandemic period, we observed an increase in total number of patient with ST elevation myocardial infarction patients compared to the pre-pandemic period. Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients (1953 pg/ml versus 259 pg/ml for troponin I and 14 ng/ml versus 6 ng/ml for CK-MB p < 0.0001, p = 0.02, respectively). Type 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative to the pre-pandemic group (10 versus 0, p = 0.003). Post-procedural TIMI flow grade was lower in the pandemic group and distal embolisation and TIMI thrombus score were significantly higher in the pandemic group compared to the pre-pandemic group (p = 0.001, p = 0.02, and p = 0.002, respectively). The number of patients who underwent bypass surgery was much lower compared to pre-pandemic period (27 versus 8, p < 0.0001). There was no statistically significant difference in hospital mortality and short-term all-cause mortality among groups (p > 0.05). CONCLUSION: Although clinical, laboratory, and angiographic features were worse in ACS patients during pandemic, the mortality rate of ACS was similar in both pre-pandemic and pandemic era. It is important to keep coronary intensive care units and catheter labs open and fully-functioning during the pandemic.

QT interval analysis in patients with chronic liver disease: a prospective study.

In previous studies, it has been shown that QT interval prolongation is related to an increased mortality rate in chronic liver disease (CLD). But QT dispersion (QTd) and its clinical significance in CLD has not been well studied. The objectives of this study were to investigate the relation between QTd and severity of the disease and determine its prognostic value in cirrhotic patients. Thirty-three consecutive patients with cirrhosis and 35 sex- and age-matched healthy subjects were studied. QT intervals and QT dispersions were measured on admission, and all intervals were corrected for heart rate according to Bazett's formula. The authors analyzed the potential relationship between QT parameters and the disease severity according to Child-Pugh classification and compared these values between survivors and nonsurvivors after a 3-year follow-up. Child-Pugh classification is used to assess liver function in cirrhosis. Corrected QT (QTc) prolongations were found in 32% of patients with cirrhosis and 5.7% of the healthy controls (p <0.001). The prevalence of increased (>70 ms) corrected QT dispersion (QTcd) was 45% in patients with cirrhosis. According to Child-Pugh criteria: QTd, maximum QT interval (QTmax), corrected QTmax (QTcmax), and QTcd in class C were significantly higher than those of class A and B (p <0.05, for all comparison). But there was no significant difference between class A and B in QTmax, QTcmax, QTd, and QTcd. There were 10 (30%) deaths from all causes during 3-year follow-up in the study group. Cox regression analysis showed that QTd and QTcd were better mortality indicators than QTmax and QTcmax, and Child's classification was the best predictor for mortality among all variables. In conclusion, QT dispersion and corrected QT dispersion parameters were better mortality indicators than other QT interval parameters and also may give additional prognostic information in patients with chronic liver disease.

Increased high sensitive CRP level and its significance in pathogenesis of slow coronary flow.

Previous studies have suggested that microvascular abnormalities cause slow coronary flow (SCF). The role of inflammation has not been investigated, to date. The purpose of this study was to determine the role of inflammation in pathogenesis of SCF. The study included 32 patients with angiographically proven SCF (mean age 49 +/-9 years) (group I) and 30 subjects with normal coronary flow (mean age 48 +/-8 years) (group II). Blood samples were collected for high sensitive CRP (hs-CRP) measurements. Thrombolysis in myocardial infarction frame count (TFC) was compared in both groups. Distribution of sex, age, body mass index (BMI), arterial blood pressure, and ejection fraction were similar in the 2 groups. TFC was significantly higher in group I than in group II for each artery including left anterior descending coronary artery (LAD), left circumflex artery (Cx), and right coronary artery (RCA) (38.9 +/-6.6 vs 22.1 +/-1.8 frames, p = 0.0001; 39.6 +/-4.9 vs 22.3 +/-1.8 frames, p = 0.001 ; 39.0 +/-3.8 vs 22.0 +/-1.8 frames, p = 0.001, respectively). In group I, serum hs-CRP concentration was significantly higher than that of group II (0.6 +/-0.58 vs 0.24 +/-0.1 mg/dL p = 0.03). Correlation analysis showed a positive correlation between hs-CRP level and TFC for each artery (for CTFC(LAD), r = 0.36 p = 0.004; for TFC(Cx), r = 0.42 p = 0.003; and for TFC(RCA), r = 0.42, p = 0.0001 respectively). Increased hs-CRP level suggests that inflammation may be associated with pathogenesis of SCF or at least in part contributes to its pathogenesis. Increased hs-CRP level may also be an early marker of impaired coronary blood flow.

Serum levels of selenium, zinc and copper in patients with coronary artery ectasia.

BACKGROUND: It is well established that the deficiency of trace elements may lead to oxidative stress in many tissues. Several studies have shown that the deficiency of trace elements may play a role in the pathogenesis of various heart diseases, including coronary artery disease. This study was designed to determine the serum levels of trace elements, such as selenium, zinc, and copper, in patients with isolated coronary artery ectasia and to confirm previously documented changes in the trace element status in coronary artery disease. It also investigated the relationship between the level of trace elements and the extent of ectatic involvement in patients of coronary artery ectasia. METHODS AND RESULTS: The serum selenium, zinc and copper levels were measured in 37 patients of coronary artery ectasia, 56 patients of coronary artery disease and 30 controls. The trace element levels were measured by atomic absorption photometry methods. The serum selenium (Se) and zinc (Zn) levels in both sets of patients were significantly lower than in the control group (Se: 127 +/- 10 microg/L and 126 +/- 9 microg/L vs. 147 +/- 12 microg/L, p < 0.001; Zn: 557 +/- 11 microg/L and 554 +/- 13 microg/L vs. 620 +/- 13 microg/L, p < 0.001). However, the serum copper (Cu) levels were similar in all patients and controls (964 +/- 12 microg/L and 973 +/- 14 microg/L vs. 956 +/- 17 microg7/L, p > 0.05). CONCLUSION: These results suggest that coronary artery ectasia is associated with the deficiency of the trace elements selenium and zinc. Thus, these elements may play an important role in the pathogenesis of coronary artery ectasia, as well as in coronary artery disease.

Brain natriuretic peptide and P wave duration in dialysis patients.

OBJECTIVES: P wave duration and dispersion, defined as the difference between the maximum and minimum P duration, are regarded as very important non-invasive ECG markers for assessing atrial arrhythmia risk. Plasma brain natriuretic peptide (BNP) level is an independent predictor of recurrence of atrial fibrillation. We compared the effects of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) on P wave duration, P dispersion, and BNP in end-stage renal disease (ESRD) patients and examined the relationship between BNP levels, P wave duration, and P dispersion. DESIGN AND METHODS: Age-matched 22 HD patients (mean age 52.3 +/- 14.0 years) and 19 CAPD patients (mean age 46.7 +/- 10.9 years) were studied. RESULTS: BNP levels were greater in HD patients before the HD session (459.0 +/- 465.1 pg mL(-1)) than in CAPD patients (139.0 +/- 170.1 pg mL(-1)). The maximum and minimum P duration, and P dispersion, were similar for both groups (P > 0.05). Whereas BNP levels were negatively related to minimum P duration (r = -0.518, P = 0.019), BNP levels were positively correlated with systolic blood pressure and diastolic blood pressure (r = 0.672, P = 0.001 and r = 0.497, P = 0.022, respectively) in HD patients. CONCLUSIONS: Whereas BNP levels are higher in HD patients when they are at peak-volume status, just before HD, P wave duration and P dispersion were similar for both groups. A negative relationship was detected between BNP levels and minimum P duration in HD patients. Expansion of extra-cellular volume causing myocardial stretching may be the principal cause of increased BNP in HD patients. A functional relationship between BNP and the P wave was not found. Additional studies are needed to evaluate the effect of BNP on the P wave.

Relationship between cytokines and tumour markers in patients with chronic heart failure.

AIMS: Serum levels of some cytokines and tumour markers are elevated in patients with chronic heart failure (HF). We aimed to investigate the relationship between circulating levels of cytokines and tumour markers in patients with HF. METHODS: We included 35 HF patients and 33 normal controls. HF patients were divided into two groups: mild HF (NYHA class I/II) (n=10) and severe HF (NYHA class III/IV) (n=25). Serum cytokine levels (TNF-alpha, IL-1 beta, IL-6, and IL-10) were measured by ELISA and tumour markers (CA 125, CA 19-9, CA 15-3, CEA and AFP) by chemiluminescent enzyme immunoassay. RESULTS: Serum levels of TNF-alpha, IL-6, and IL-10 as cytokines, and CA 125 and CA 19-9 as tumour markers were significantly higher in HF patients than in normal controls (p<0.0001 for all). Serum levels of TNF-alpha, IL-6 and IL-10 and CA 125 in the severe HF patients were significantly higher than in the mild HF patients (p<0.001 for all). Correlation analysis showed that CA 125 was positively related to TNF-alpha (r=0.624, p<0.001), IL-6 (r=0.671, p<0.001), and IL-10 (r=0.545, p<0.001) in HF. CONCLUSION: These findings show that CA 125 is markedly elevated in patients with HF, and correlates with serum TNF-alpha, IL-6 and IL-10 levels. Therefore, we speculate that among the tumour markers studied, only CA 125 is closely related to the cytokine system.

Elevated plasma homocysteine levels in patients with isolated coronary artery ectasia.

OBJECTIVE: Coronary artery ectasia is a variant of coronary atherosclerosis. Hyperhomocysteinemia has emerged as a major, independent risk factor for cardiovascular diseases. The purposes of this study were to determine plasma hyperhomocysteine levels in patients with coronary artery ectasia, and to compare patients with coronary artery ectasia, coronary artery disease, and controls with normal coronary angiogram. METHOD: The study population included 37 patients with coronary artery ectasia and 36 patients with coronary artery disease. The control group consisted of 32 patients with angiographically proven normal coronary arteries. Plasma hyperhomocysteine levels were measured in all study patients with an enzyme-linked immunosorbent assay. RESULTS: Plasma homocysteine levels were significantly higher in patients with both coronary artery ectasia and coronary artery disease than in the controls (14.8+/-1.1 and 15.9+/-0.8 vs. 2.5+/-0.6 micromol/l; P<0.001 and P<0.001, respectively). No significant differences in plasma homocysteine levels were found among CAE and CAD groups (P>0.05). CONCLUSIONS: We have demonstrated that patients with coronary artery ectasia and coronary artery disease have increased plasma hyperhomocysteine levels compared with the controls. These findings suggest that hyperhomocysteinemia may play an important role in the pathogenesis of coronary artery ectasia as in coronary artery disease.

Impact of coronary collateral circulation on QT dispersion in patients with coronary artery disease.

OBJECTIVE: The aim of this study was to assess the effect of coronary collateral circulation (CCC) on QT dispersion (QTD) in coronary artery disease. BACKGROUND: A prolonged QTD has been linked to increased heterogeneity of ventricular repolarization implicated in the genesis of ventricular arrhythmias and has been associated with an adverse prognosis in patients with coronary artery disease. METHOD: CCC and corrected QTD (QTcD) were established in patients who had at least 85% stenosis in the left anterior descending coronary artery or in proximal part or in the body of the right coronary artery. Furthermore, left ventricular function score was determined for all the patients. RESULTS: While CCC was not present (CCC grade 0) in 32 patients, 68 patients were observed with CCC (CCC grade > or =1). Mean QTcD was higher in patients who had CCC grade > or =1 than in patients with grade 0 (64.3+/-3.5 and 46.8+/-2.7, respectively, P=0.002). We detected a significant correlation between the collateral score and QTcD (r=0.354, P=0.001). CCC grade > or =1 patients had higher mean left ventricular function scores than grade 0 patients (P=0.048). Left ventricular function score and QTcD were observed to be correlated (r=0.200, P=0.046). CONCLUSION: CCC in chronic coronary artery disease was not established to have a positive decreasing effect on QTcD. On the contrary, QTcD values were observed to be even higher in patients with well developed CCC. Further research including larger series and long-term follow-up is required to investigate this issue.

Prevalence and clinical significance of a patent foramen ovale in patients with chronic obstructive pulmonary disease.

BACKGROUND: A patent foramen ovale (PFO) is not widely recognized as a factor contributing to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). We therefore sought to clarify the prevalence and clinical significance of a PFO in patients with COPD, and to analyze the factors related to its occurrence. METHODS: This study included 52 consecutive stable patients with COPD and 50 healthy controls. The demographic and clinical features of the study group were noted. To test for a PFO, standard and contrast transthoracic echocardiographic examinations were performed while resting and during the Valsalva maneuver (VM). Patients performed 6-min walking tests (6 MWT), and the distances traveled were measured. RESULTS: During VM, we detected a PFO in 23 COPD patients and 10 healthy controls (P<0.01). A PFO was detected while resting in 11 COPD patients, but in none of the controls (P=0.001). Comparison of multiple parameters between COPD patients with and without a PFO during VM did not reveal any clinically significant differences. When we compared COPD patients with and without a PFO during resting, however, we found that the former had longer durations of disease, lower PaO2 and SaO2, higher dyspnea scores, shorter distances walked during 6 MWT and higher desaturation rates (P<0.05). Logistic regression analysis showed that longer duration of disease, lower SaO2 and higher systolic pulmonary artery pressure were independent predictors of the occurrence of a PFO in resting COPD patients. CONCLUSIONS: The prevalence of a PFO is higher in patients with COPD than in healthy individuals. The presence of a PFO while resting may contribute significantly to the deterioration of arterial oxygenation and performance status. These findings indicate that a PFO may be a principle cause of hypoxemia in patients with COPD.

Trace element status (Se, Zn, Cu) in heart failure.

OBJECTIVE: It has been speculated that trace elements may play a role in the pathogenesis of heart failure. In the present study, we aimed to assess serum concentrations of selenium (Se), zinc (Zn) and copper (Cu) in patients with heart failure (HF) and to compare idiopathic dilated cardiomyopathy (IDCM) and ischemic cardiomyopathy (ICM) patients with healthy controls. METHODS: This study population included 54 HF patients (26 IDCM patients and 28 ICM patients) and 30 healthy subjects. Serum levels of selenium, zinc, and copper were assessed by atomic absorption spectrophotometry method. RESULTS: Serum concentrations of Se and Zn in HF patients were significantly lower than in healthy controls (p=0.000 and p<0.01, respectively). However, serum Cu concentrations in these patients were significantly higher than in controls (p=0.000). There were no significant difference in the trace elements status between IDCM and ICM patients (p>0.05 for all parameters). Relationships of the serum trace element concentrations studied with echocardiographic and hemodynamic parameters were not statistically significant. CONCLUSION: Our study showed that heart failure is associated with lower Se and Zn concentrations, and higher Cu concentration, and serum Se, Zn and Cu element profiles were similar in IDCM and ICM.

Tumour marker levels in patients with chronic heart failure.

BACKGROUND: Carbohydrate Antigen 125 (CA 125), a marker for ovarian cancer has been reported to increase in relation to the severity of heart failure. OBJECTIVE: To evaluate the serum levels of CA 125 and other tumour markers, in patients with chronic heart failure. METHODS: Blood levels of CA 125 and other tumour markers were determined in 44 heart failure patients (16 males and 28 females; age 66.3+/-6.5 years) before and after optimal medical treatment. Levels were also evaluated in 30 healthy volunteers (11 males and 19 females; age 65.7+/-9.8 years). The results in the heart failure patients were grouped according to clinical status (New York Heart Association Class). The mean duration of follow-up was 3+/-1.5 months. RESULTS: The mean serum level of CA 125 was 81.9+/-91 in the patient group and 7.5+/-4.8 in control group (p<0.001). The mean CA 19-9 level in the patient group (16.8+/-16.6) was significantly higher than in the control group (4.5+/-2.6) (p<0.001). CA 125 levels increased as the New York Heart Association (NYHA) functional class increased (Class I/II: 17.7+/-22.4 U/ml; Class III: 99.6+/-92.1 U/ml; Class IV 136.4+/-102.8 U/ml; p<0.05). There were no significant differences in serum CA 125 and other tumour marker levels before and after optimisation of treatment. Significantly higher serum CA 125 levels were found in patients with pericardial effusion (p=0.002) when compared to patients without pericardial effusion. CONCLUSION: Among the tumour markers evaluated, only CA 125 seems to be specifically related to the presence and severity of heart failure and also the presence of pericardial fluid. Therefore, measurements of CA 125 serum levels might be proposed for the serial assessment of heart failure. Whether CA 125 has a specific biological role in heart failure requires further investigation.

Possible malignant neuroleptic syndrome that associated with hypothyroidism.

A 54-year-old woman with schizophrenia presented to hospital with unconsciousness, fever and marked muscle rigidity. She had been given fluphenazine decanoete 20 mg intramuscularly 15 days before the admission and she had continued taking haloperidol 20 mg daily and oral biperiden 2-4 mg. She was extremely rigid and unresponsive. On laboratory investigations revealed: serum sodium 120 mEq/l, creatinine phosphokinase 12,980 IU/l (normal up to 170), lactate dehydrogenase 1544 IU/l (150-500), free trioidothyronine < 1.00 pg/ml (1.5-4.5), free throxyine 0.76 ng/dl (0.8-1.9), thyroid stimulating hormone 1.14 microU/ml (0.4-4), cortisol (at 8.00 a.m.) 9 microg/dl (5-25). Antipsychotic drugs were withdrawn after admission. A diagnosis of secondary adrenal insufficiency and secondary hypothyroidism was made. Hormonal substitution with hydrocortisone and levothyroxine and correction of hyponatremia with intravenous hypertonic saline solution resulted in rapid improvement of symptoms and signs. It seems that the symptoms and signs of hypothyroidism and hyponatremia were attributed to acute psychosis in this patient. As a conclusion failure to recognize the endocrinopathy may not only produce recovery difficulties but also psychiatric and endocrine repercussions if psychotropic medications are given in such masked cases.

Increased aortic stiffness in patients with coronary artery ectasia.

OBJECTIVE: Alterations in aortic stiffness may reflect the elastic properties of the larger arteries. In many diseases, aortic elastic properties have been investigated to show whether the larger arteries are involved. The elastic properties of aorta in patients with coronary artery ectasia, however, have not been studied yet. We aimed to investigate aortic stiffness parameters in patients with coronary artery ectasia and to compare patients with coronary artery ectasia and coronary artery disease with the control group. METHOD: Thirty-three patients with coronary artery ectasia, 31 patients with coronary artery disease and 30 patients with angiographically normal coronary arteries were included in this study. Aortic diameters were measured on the M-mode tracing obtained at a level 3 cm beyond the aortic valve at parasternal long-axis view. Aortic diameter change, aortic strain, aortic distensibility and stiffness parameters were measured as aortic stiffness parameters. RESULTS: Aortic diameter changes were fewer in the coronary artery ectasia and coronary artery disease group than in the control group (0.4 +/- 0.1 and 0.3 +/- 0.1 vs. 0.8 +/- 0.2; P < 0.001). Aortic distensibility and aortic strain were significantly lower in patients with coronary artery ectasia and coronary artery disease than in the controls (for aortic distensibility P < 0.001 and for aortic strain P < 0.001, < 0.001, respectively). In contrast, a significantly higher aortic stiffness index was observed in patients with coronary artery ectasia and coronary artery disease than in the control group (14.2+/-2.6 and 18.1 +/- 2.9 vs. 5.9 +/- 1.8; P < 0.001, respectively). CONCLUSIONS: The impairment in aortic elastic properties in patients with coronary artery ectasia indicates that this disease is a generalized disease rather than a localized disease of the coronary arteries.

Decreased carotid intima-media thickness in patients with coronary artery ectasia compared with patients with coronary artery disease.

BACKGROUND: Although atherosclerosis is supposed to be responsible for more than 50% of coronary artery ectasia, the precise pathology of coronary artery ectasia is not clearly understood. A histopathological examination of ectatic segments has revealed mainly destruction of the media layer of the artery. In the present study, we assessed carotid intima-media thickness and common carotid artery diameter in patients with and without coronary artery ectasia. MATERIALS AND METHODS: Thirty-five consecutive patients with coronary artery ectasia and coronary artery disease and 35 age and sex-matched patients with coronary artery disease alone were included in the study. The common carotid artery was studied as the longitudinal plane within 10 mm from the bifurcation of the common carotid artery. The intima-media thickness was measured in the far wall at end-diastole from the B-mode screen to a point within the 10-mm segment proximal to the bifurcation by one investigator blinded to clinical data. RESULTS: No significant differences with respect to age, body mass index, hypertension, diabetes mellitus, hypercholesterolemia and smoking habits were observed between the two groups studied. Intima-media thickness of the common carotid artery of the patients with coronary artery ectasia was significantly lower than that of the patients with coronary artery disease alone (0.71 +/- 0.13 vs. 0.77 +/- 0.09 mm, respectively, P = 0.04). CONCLUSION: Decreased intima-media thickness of the carotid artery in patients with coronary artery ectasia and coronary artery disease may have pathogenic mechanisms different from coronary artery disease per se.

Aortic valve calcification: association with bone mineral density and cardiovascular risk factors.

BACKGROUND: Cardiovascular risk factors are reported to increase the incidence of aortic valve calcification. Among older women, low bone mineral density appears to be associated with increased prevalence of aortic calcification. We aimed to assess and compare cardiovascular risk factors and bone mineral density of patients with and without aortic valve calcification. MATERIALS AND METHODS: Cardiovascular risk factors and bone mineral density measurements have been assessed in 49 patients with aortic valve calcification and in 65 patients without aortic valve calcification. All patients were subsequently referred to the nuclear medicine department to measure bone mineral density after echocardiographic evaluation. RESULTS: No statistically significant differences were observed between the two groups with respect to sex, body mass index, history of coronary artery disease, diabetes mellitus, hypercholesterolemia, and smoking status. Although height and weight of the patients with aortic valve calcification were significantly lower than those of patients without aortic valve calcification, they were not independent risk factors. Age and hypertension were found to be independent positive risk factors for aortic valve calcification, whereas T score was found to be negatively associated with aortic valve calcification. CONCLUSION: We have shown that aortic valve calcification is positively associated with age and hypertension, whereas bone mineral density is negatively associated with aortic valve calcification. The mechanism underlying the association between decreased bone mineral density and aortic valve calcification remains to be clarified in further studies.

Acute myocardial infarction with normal coronary arteries in a young man with the Behcet's disease.

Behcet's disease (BD) is an inflammatory disorder of unknown origin, which usually presents with mucocutaneous, ocular, articular, vascular, gastrointestinal and central nervous system manifestations. Although cardiac involvement is not infrequent as a manifestation of Behcet's disease, coronary arteritis is very rarely reported. We suggest that the diagnosis of coronary arteritis should be considered in patients presenting acute myocardial infarction especially in young patients as underlying cause.

Isolated large true contractile left ventricular diverticulum mimicking ischemia in an adult patient: a case report.

Congenital diverticulum of the ventricle is a rare cardiac abnormality that is characterized by local embryologic development failure of the ventricular muscle. It can be found as an isolated form or associated with other cardiac abnormalities. Clinically, it has been reported that it can lead to heart failure, arrhythmia, or chest pain, although frequently the course is asymptomatic. We present a patient who was referred to our clinic with chest pain due to isolated left ventricular diverticulum mimicking myocardial ischemia.

Significance of serum trace element status in patients with rheumatic heart disease: a prospective study.

It is known that certain trace elements can affect various heart diseases. In this study, we aimed to evaluate the changes in concentrations of certain serum trace elements in patients with chronic rheumatic heart disease (RHD). Serum analysis of selenium (Se), zinc (Zn), and copper (Cu) trace elements was assayed by atomic absorption spectrophotometry. RHD patients had significantly lower serum concentrations of Se and Zn than control subjects (p < 0.05 and p < 0.001, respectively). However, the serum Cu concentration was significantly higher in RHD patients than in controls (1.93 +/- 0.59 microg/L vs 1.06 +/- 0.29 microg/L; p < 0.001). Similarly, the Cu/Zn ratio in RHD patients was higher than in control subjects (4.70 +/- 0.92 vs 1.68 +/- 0.45; p < 0.001). Additionally, no significant correlation was found among these trace element concentrations and the functional capacity classes (p > 0.05). RHD patients had decreased serum Se and Zn element concentrations and increased serum Cu element concentration. We suggest that Se and Zn deficiency might be contributory factors in the development of rheumatic heart disease, and a high Cu concentration and a high Cu/Zn ratio might reflect an ongoing inflammatory process in this disease.

Pericardial hydatid cyst mimicking acute coronary syndrome.

Cardiac hydatid cysts are found mostly within myocardium. Only a few cases of pericardial location have been reported. Patients with hydatid cysts are usually asymptomatic. A 46-year-old man with clinical and electrocardiographic features mimicking acute myocardial ischemia was hospitalized for further evaluation. Detailed imaging and laboratory investigation revealed a pericardial hydatid cyst. The patient underwent operation for curative excision. After surgery, the patient's symptoms resolved and his clinical status improved. We think that pericardial hydatid cyst should be considered in the differential diagnosis of patients with angina-like pain-especially in geographic areas where hydatid cysts are endemic.

vWf levels as a circulating marker of endothelial dysfunction in patients with hypertrophic cardiomyopathy.

BACKGROUND: The aim of the present study was to investigate whether the von Willebrand factor levels, as a possible indicator of endothelial dysfunction, is increased in hypertrophic cardiomyopathy, and also whether it is related to the clinical status of hypertrophic cardiomyopathy. METHODS AND RESULTS: The study group comprised 29 patients with hypertrophic cardiomyopathy and 29 healthy age- and gender-matched control subjects. There was no significant difference in von Willebrand factor levels between study group (77.0 +/- 23.1%) and control group (88.5 +/- 34.2%). There was no statistically significant difference between control group (88.5 +/- 34.2%) and functional class I/II group (82.0 +/- 24.3%), between control group and functional class III group (67.6 +/- 18.3%) and between functional class I/II group and functional class III group with respect to the von Willebrand factor levels. CONCLUSIONS: The results suggest that von Willebrand factor levels, as a possible indicator of endothelial dysfunction, are not increased in patients with hypertrophic cardiomyopathy and von Willebrand factor levels are not related to functional class in these patients.