RESUMO
OBJECTIVES: In this article, our aims were to analyze and assess the data related to coronary revascularization rates, particularly in recent years. STUDY DESIGN: For this purpose, results of important studies, statistics of the Organisation for Economic Co-operation and Development (OECD) countries and data from Turkey's Social Security Agency (SSA) were analyzed for the first time. Until recently, there has been no healthy digital database regarding revascularization rates in Turkey. In the years following the establishment of SSA, it became possible to collect and analyze data obtained from the Medulla database of the Agency. Using the data from the Agency for the period 2009-2011, revascularization rates and cost analyses were performed. RESULTS: Between 2000 and 2010 in European countries as well as in other OECD countries, the percutaneous coronary intervention (PCI) rate was on average 75% of the total revascularization rate and neared 80%. In some countries, the rate has exceeded 85%. In our country, in 2009, 2010 and 2011, the number of coronary angiography procedures and as a result PCI has steadily increased. The rate for PCI was 66.8% in 2009, but it increased to 74% in 2011. At the same time, PCI accounted for 2/3-4/5 of all revascularization procedures. In the cost analysis, however, PCI constituted only 1/5-1/4 of the costs of all revascularization procedures. CONCLUSION: This report is the first analysis in this area and it gives an initial idea about the current situation of the numerical and financial aspects. This analysis has provided the opportunity to obtain more accurate information about coronary revascularization rates in Turkey and to compare the data to that of other countries.
Assuntos
Ponte de Artéria Coronária/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Europa (Continente) , Humanos , TurquiaRESUMO
BACKGROUND: Extensively used lipid-lowering statins have also non-lipid-lowering, pleiotropic effects. Previous studies have demonstrated that a pre-procedural single dose of atorvastatin is associated with reduced peri-procedural myocardial injury. AIM: The aim of the present study was to demonstrate the effect of a single high loading dose (40 mg) of rosuvastatin on peri-procedural myocardial injury. METHODS: Two hundred ninety nine statin-naive patients with stable angina and de novo lesions eligible for PCI were randomized to a rosuvastatin-treatment (n = 153) and to a no-treatment (n = 146) group. A 40 mg loading dose of rosuvastatin was administrated 24 h before the PCI. CK-MB and cTnI levels were measured before and 12 h after the procedure. RESULTS: Baseline characteristics were fairly similar between the two arms. The incidence of a CK-MB and cTnI elevation >3x ULN in the rosuvastatin group was significantly lower compared to the control group (0.7% vs. 11.0%, p < 0.001 and 10.5% vs. 39.0%, p < 0.001, respectively). Similarly, the incidence of any CK-MB and cTnI elevation > ULN in the rosuvastatin group was significantly lower compared to the control group (10.5% vs. 34.2%, p < 0.001 and 20.9% vs. 61.6%, p < 0.001, respectively). In addition, CK-MB and cTnI values 12 h after the PCI were significantly lower in the rosuvastatin group compared to the control group (20.13 +/- 7.24 U/L vs. 27.02 +/- 18.64 U/L, p < 0.001 and 0.14 +/- 0.34 ng/ml vs. 0.35 +/- 0.40 ng/ml, p < 0.001, respectively). CONCLUSION: A single high loading dose of rosuvastatin reduces the incidence of peri-procedural myocardial necrosis and infarction effectively.
Assuntos
Angina Pectoris/terapia , Angioplastia Coronária com Balão/efeitos adversos , Fluorbenzenos/uso terapêutico , Complicações Intraoperatórias/prevenção & controle , Infarto do Miocárdio/prevenção & controle , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico , Idoso , Biomarcadores/sangue , Creatina Quinase Forma MB/sangue , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Incidência , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Rosuvastatina Cálcica , Resultado do Tratamento , Troponina I/sangueRESUMO
BACKGROUND: Cardiac resynchronization therapy has been increasingly used for patients with heart failure. However, unstable and dislocated coronary sinus leads reduce the effectiveness of this important intervention. AIM: To examine the long-term effects of coronary sinus side branch stenting on sensing and pacing parameters of the left ventricular leads. METHODS: A total of eight patients (six males; two females; mean age, 56.6 ± 14.4 years) whose coronary sinus lead dislocated during the procedure were included in the study. Targeted coronary sinus side branch stenting was performed to stabilize the leads. Sensing and pacing parameters including lead impedance, capture threshold, and R-wave amplitude were measured at implantation, first month, sixth month, and every 6-month period. RESULTS: Mean follow-up period was 30.4 ± 7.4 months. At the time of implantation, lead impedance, capture threshold, and R-wave amplitude were 656 ± 162 Ω, 1.1 ± 0.5 V, and 13.0 ± 6.8 mV, respectively. No statistically significant mean lead impedance, capture threshold, and R-wave amplitude differences were observed between at the time of implantation and at the time of last follow-up (697 ± 164 Ω, 1.1 ± 0.5 V, 12.8 ± 6.9 mV, respectively). CONCLUSION: In this long-term study, coronary sinus side branch stenting for the stabilization of dislocated leads seems to be effective.
Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca , Seio Coronário/cirurgia , Eletrodos Implantados , Stents , Adulto , Idoso , Feminino , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Falha de Prótese , Radiografia , Resultado do TratamentoRESUMO
BACKGROUND AND AIM OF THE STUDY: Despite recent improvements in diagnostic and therapeutic interventions, infective endocarditis (IE) is still associated with high in-hospital mortality rates. The study aim was to determine the clinical, laboratory and echocardiographic features of IE, and to evaluate the risk factors for in-hospital mortality. METHODS: A retrospective cohort study design was employed, with a main outcome measure of in-hospital mortality. A total of 107 patients (79 males, 28 females; mean age 45 +/- 16 years) admitted with the modified Duke criteria for definitive IE were included in the study during a five-year period between January 2004 and December 2008. RESULTS: Among the patients, the mitral valve alone was involved in 45% of cases, the aortic valve in 36%, tricuspid valve in 11%, and multiple valves in 8%. Forty-seven patients (44%) had prosthetic valves. Blood cultures were positive in 71 patients (66%). The most common isolated microorganisms were staphylococci, streptococci and Brucella melitensis. The in-hospital mortality rate was 27%. Leading causes of death were multi-organ failure and heart failure. In univariate analysis, factors associated with death were a longer duration of symptoms before hospitalization, previous history of IE, white blood cell count > or = 10,000/mm3, serum creatinine level > or = 2 mg/dl, vegetation size >15 mm, involvement of multiple valves, existence of severe regurgitation, cardiac abscess, and neurologic complications. Multivariate analysis showed that risk factors for mortality were multivalvular involvement (hazard ratio (HR) 4.7; 95% confidence interval (CI) 1.3-17.6; p = 0.021), vegetation size >15 mm (HR 5.5; 95% CI 2.1-14.6; p = 0.001), serum creatinine > or = 2 mg/dl (HR 4.1; 95% CI 1.8-9.4; p = 0.001), and previous history of IE (HR 3.5; 95% CI 1.2-11; p = 0.026). CONCLUSION: Multivalvular involvement, vegetation length >15 mm, serum creatinine level > or = 2 mg/dl on admission, and a previous history of IE, were independent predictors for in-hospital mortality in IE.
Assuntos
Endocardite Bacteriana/mortalidade , Doenças das Valvas Cardíacas/mortalidade , Mortalidade Hospitalar , Adulto , Idoso , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/microbiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Almost the same pathophysiological mechanism has been suggested for both atherosclerosis and calcific aortic stenosis (AS). In this study, we examined any association between ascending aortic pressure-derived indices and hemodynamic characteristics of calcific AS. METHODS: A total of 90 patients were studied (26 males, 64 females; mean age: 64.4 +/- 11.3 years). The study population consisted of two groups: AS and a control group. Both groups were well matched. Ascending aortic pressure-derived indices were obtained from all patients via catheterization. RESULTS: Two groups were well matched according to demographic characteristics. Aortic pulse/FPPs (fractional pulse pressure = aortic pulse pressure/ aortic mean pressure), and PI (pulsatility index = aortic pulse pressure/aortic diastolic pressure) were significantly higher in patients with AS than in those without. Mean aortic mean gradient had significant positive correlation with aortic diastolic pressure, FPP and PI. The multiple-adjusted odds ratios of the risk of AS was 4.51 (95% CI 1.63-12.48) and 4.34 (95% CI 1.59-11.88) for the higher aortic FPP and PI levels compared with lower levels, respectively. CONCLUSION: Ascending aortic pressure-derived indices were significantly and independently associated with the presence and severity of calcific AS. This confirms the participation of blood pressure in the pathogenesis of AS.
Assuntos
Aorta/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Pressão Sanguínea , Calcinose/fisiopatologia , Idoso , Estenose da Valva Aórtica/etiologia , Diástole , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Índice de Gravidade de DoençaRESUMO
Mean platelet volume (MPV) is an indicator of platelet activation, a central process in the pathophysiology of coronary heart disease (CAD). The importance of slow coronary flow (SCF) phenomenon results from its association with angina pectoris, acute myocardial infarction, hypertension and sudden cardiac death. The aim of this study is to evaluate the values of MPV in patients with SCF. MPV was measured in 84 consecutive patients with SCF and 88 patients with CAD and 84 control subjects. The association between thrombolysis in myocardial infarction (TIMI) frame count (TFC) and MPV level and other clinical and laboratory parameters were evaluated. There were no statistically significant differences in MPV between SCF group and CAD group. MPV was significantly higher in patients in the both SCF and CAD groups, compared with control group. The TFC for all the epicardial coronary arteries and the mean TFC were significantly higher in the SCF group than the both CAD group and control group. The mean TFC was positively and moderately correlated with MPV in the whole study population. To determine the independent predictors of mean TFC, a stepwise linear regression analysis was performed by including the parameters that were correlated with the mean TFC in the bivariate analysis. MPV level was the only independent predictor of the mean TFC (b = 0.312, p < 0.001). These findings have shown that MPV level is significantly associated with coronary blood flow and that elevated MPV level might be an independent predictor for the presence of SCF. We believe that further studies are needed to clarify the role of MPV in SCF complicated CAD, especially in relation to angiographic and clinical parameters, before we conclude that MPV to be used as a follow-up marker during the management of relevant patients.
Assuntos
Plaquetas/patologia , Tamanho Celular , Circulação Coronária/fisiologia , Doença das Coronárias/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Colesterol/sangue , Angiografia Coronária/métodos , Doença das Coronárias/sangue , Doença das Coronárias/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de PlaquetasRESUMO
BACKGROUND: A zoonotic infection caused by Brucella spp., brucellosis, is endemic in some areas of the world, like in our country. One of the most devastating conditions related to this infection is endocarditis, although it is rare. Unfortunately, adequate studies on the characteristics of Brucella endocarditis have not been performed. In addition, there was no consensus on optimal type and duration of medical and interventional therapies. AIM: To answer the following questions: what are the clinical characteristics of Brucella endocarditis, which type of therapy should be performed, and can an alternative antibiotic regimen be applied? METHODS: Patients with the diagnosis of Brucella endocarditis were included in the study during a 6-year period. A total of 10 patients were interrogated for their signs, symptoms, drug use, and clinical conditions. In addition, baseline clinical and laboratory characteristics of the patients were evaluated. RESULTS: All patients in the study were male with a mean age of 55.9 +/- 12.7 years. Hospitalisation and total follow-up periods were 52.6 +/- 11.2 and 80.6 +/- 29.0 days, respectively. The most frequently presenting symptom was fever (60%). Dyspnoea and fatigue were the other frequent symptoms in descending order. Valve pathology was present in 70% of the study population. The aortic valve was affected more than the mitral valve. Affected mitral valves had rheumatic disease whereas only 57% of the aortic valves had underlying pathology. Isolation of Brucella spp. was possible in 20% of the patients. Mortality rate was 30% in our study; 20% of the patients were on medical follow-up without disease progression and with clinical stability, 60% of patients were on a combination therapy with a tetracycline group, a rifampicin, and a third-generation cephalosporin. Patients who took this combination and underwent aortic valve replacement had good clinical results with a mortality rate of 20%. The 30% of patients were on a combination therapy with a tetracycline group, rifampicin, and an aminoglycoside group. Mortality rate with this combination was 33%, although the success rate was 67%. CONCLUSION: Brucella endocarditis should be considered in the differential diagnosis in patients with vegetations on the cardiac valves, especially in endemic areas. Optimal therapy seems to be a combination of antibiotics and surgery, although medical therapy can be an alternative, especially in stable patients. Addition of a third-generation cephalosporin instead of aminoglycoside to the combination therapy is an alternative.
Assuntos
Brucelose/diagnóstico , Brucelose/terapia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/terapia , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Antibacterianos/administração & dosagem , Terapia Combinada , Diagnóstico Diferencial , Progressão da Doença , Ecocardiografia Transesofagiana/métodos , Endocardite Bacteriana/microbiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Arterial conduits having long-term patency rates have been increasingly used for bypass of coronary arteries although some risk factors for their occlusion such as recipient vessel size, older age, and hyperlipidaemia have been described. Obesity, on the other hand, has been well established as a coronary risk factor. However, the effects of obesity on patency of arterial conduits, especially the internal mammary artery, have not been studied previously. AIM: To assess the long-term effects of obesity on left internal mammary artery (LIMA) patency. METHODS: Angiograms of all patients with a LIMA conduit only were analysed. Two groups were formed according to the LIMA patency: group 1 - patients with occluded LIMA (n = 59), and group 2 - patients with patent LIMA (n = 68). Baseline demographic, haemodynamic, and laboratory characteristics of patients in both groups were compared. Obesity was defined as body mass index > or = 30 kg/m2. RESULTS: The mean BMI value in group 1 was significantly higher than in group 2 (30.4 +/- 3.1 vs. 28.7 +/- 4.7, p = 0.025). The two groups differed in time from surgery, drug use, and HDL cholesterol level. In addition, patients in both groups were categorised by BMI, and obese and non-obese groups were formed. Higher BMI was significantly associated with LIMA occlusion such that 71% of patients in group 1 had increased BMI, compared with 25% of patients in group 2 (p < 0.001). Multivariate analysis showed that multiple adjusted OR of the risk of LIMA occlusion was 7.41 (95% CI 3.38-16.28) for patients with increased BMI. CONCLUSIONS: Obesity (> or = 30 kg/m2) has a significant and independent negative effect on the patency of the LIMA graft.
Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Artéria Torácica Interna/diagnóstico por imagem , Obesidade/complicações , Idoso , Idoso de 80 Anos ou mais , Angiografia , Prótese Vascular , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Doadores de Tecidos , Grau de Desobstrução VascularRESUMO
OBJECTIVES: It has been shown that serum uric acid (SUA) constitutes an important independent risk factor for cardiovascular disease. We investigated SUA levels in patients with coronary artery ectasia (CAE). STUDY DESIGN: Serum uric acid levels were measured in three groups of patients who underwent coronary angiography. One group consisted of 97 consecutive patients (69 males, 28 females; mean age 58.1+/-9.5 years) with isolated CAE, another group included 104 patients (79 males, 25 females; mean age 58.4+/-8.8 years) with coronary artery disease (CAD), and finally 90 subjects (66 males, 24 females; mean age 57.6+/-10.1 years) with normal coronary arteries comprised the control group. Coronary artery ectasia was defined as a luminal dilatation of at least 1.5 times of the adjacent normal coronary segments, without any stenotic lesions. In addition, patients with CAE were assessed in four groups of severity and extension. RESULTS: The three groups were similar with respect to age, sex, body mass index, and the frequencies of hypertension, diabetes mellitus, and smoking (p>0.05). The mean SUA level did not differ significantly between the CAE and CAD groups (6.6+/-1.9 mg/dl and 6.3+/-1.9 mg/dl, respectively; p=0.184); however, compared with the control group (5.4+/-1.8 mg/dl), SUA levels were significantly higher in both groups (p<0.001). A significant correlation was found between the SUA level and the presence of isolated CAE (r=0.625; p<0.001). Multivariate logistic regression analysis showed an independent relationship between isolated CAE and SUA (OR 1.896; 95% CI 1.1048-1.5014; p<0.001). Serum uric acid levels did not differ significantly among the four subgroups of CAE severity. CONCLUSION: Our study is the first to demonstrate significantly increased SUA levels in patients with isolated CAE. Our results support relevant data suggesting an association between endothelial function and the SUA level.
Assuntos
Doença das Coronárias/sangue , Dilatação Patológica/sangue , Ácido Úrico/sangue , Idoso , Biomarcadores/sangue , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Vasos Coronários/fisiologia , Creatinina/sangue , Angiopatias Diabéticas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Triglicerídeos/sangueRESUMO
OBJECTIVE: Our study aimed to estimate the impact of addressing modifiable risk factors on the future burden of cardiovascular diseases (CVD) in the general population and in two high-risk populations (heterozygous familial hypercholesterolemia and secondary prevention) for Turkey. METHODS: One model investigated the impact of reaching the World Health Organization (WHO) voluntary targets for tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity in the general population. Another model estimated the impact of reducing LDL-cholesterol in two high-risk populations through increased access to effective treatment. Inputs for the models include disease and risk factor prevalence rates, a population forecast, baseline CVD event rates, and treatment effectiveness, primarily derived from the published literature. Direct costs to the public health care system and indirect costs from lost production are included, although the cost of programs and pharmacological interventions to reduce risk factors were not considered. RESULTS: The value of reaching WHO risk factor reduction targets is estimated at US$9.3 billion over the next 20 years, while the value of reducing LDL-cholesterol is estimated at up to US$8.1 billion for high-risk secondary prevention patients and US$691 million for heterozygous familial hypercholesterolemia patients. CONCLUSION: Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to treatment for high-risk patients are projected to greatly reduce the growing clinical and economic burden of CVD in Turkey.
Assuntos
Doenças Cardiovasculares , Custos de Cuidados de Saúde/estatística & dados numéricos , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2 , Exercício Físico , Humanos , Hipertensão , Obesidade , Prevalência , Fatores de Risco , Turquia/epidemiologiaRESUMO
BACKGROUND: Coronary artery bypass grafting has a mortality benefit compared to medical therapy in some patient groups, such as those with left main or left anterior descending coronary artery disease, and those with left ventricular dysfunction. Therefore, patency of grafts, especially sapheneous grafts, is an important issue. Aortic pulse and fractional pulse pressures are strong and independent indicators of the risk of atherosclerosis. We studied whether there was any negative effect of increased aortic pulse and fractional pulse pressures on saphenous vein graft (SVG) patency in the short term. METHODS: We evaluated aortic pulse and fractional pulse pressures of patients with occluded and patent SVGs, and investigated the relation between the two groups. One hundred and twenty-six patients with occluded SVGs with a mean age of 65.9+/-8.9 years and 114 patients with patent SVGs with a mean age of 66.9+/-8.6 years were studied consecutively. Aortic systolic and diastolic pressures were measured, and mean, pulse, and fractional pulse pressures (aortic pulse pressure/mean pressure) were calculated. RESULTS: Aortic pulse and fractional pulse pressures were significantly higher in the occluded SVG group than in the patent SVG group (58+/-19 and 48+/-13 mmHg, P=0.001; 0.59+/-0.16 and 0.50+/-0.10, P<0.001, respectively). In addition, a cut-off value of 50 mmHg and 0.52 for aortic pulse and fractional pulse pressures were determined, respectively. Increased aortic pulse (>50 mmHg) and fractional pulse (>0.52) pressures were present in 54.0 and 58.7% of patients in group 1 and 28.1 and 33.3% of patients in group 2, respectively (P=0.004 and P=0.005, respectively). Having increased aortic pulse and fractional pulse pressures increased the risk of SVG occlusion by 3.00 and 2.85-folds, respectively. The multiple-adjusted odds ratio of the risk of SVG occlusion was 6.86 (95% confidence interval 2.14-21.96) and 4.76 (95% confidence interval 1.58-14.30) for the higher aortic pulse and fractional pulse pressure levels compared with lower levels, respectively. CONCLUSION: Increased ascending aorta pulse and fractional pulse pressures have a significant and independent negative effect on the fate of SVGs.
Assuntos
Aorta/fisiopatologia , Pressão Sanguínea , Ponte de Artéria Coronária/efeitos adversos , Oclusão de Enxerto Vascular/etiologia , Veia Safena/fisiopatologia , Veia Safena/transplante , Grau de Desobstrução Vascular , Idoso , Idoso de 80 Anos ou mais , Feminino , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Coronary artery anomalies are evaluated by using catheter-based angiography. Multidetector row-computed tomography (MDCT) is a new noninvasive imaging technique that has excellent spatial resolution for detecting the origin and course of a coronary anomalous vessel. OBJECTIVE: To determine the sensitivity of multidetector computed tomography in patients who had coronary artery anomaly demonstrated by conventional coronary angiography. MATERIAL AND METHODS: A retrospective evaluation to identify 23 patients, who underwent retrospective electrocardiographic (ECG)-gated MDCT, was done and in whom an anomalous coronary vessel was found at a single center. Metoprolol (50-100 mg) was given orally to all patients to reduce heart rate so as to get high-quality MDCT images. After performing MDCT, the CT scans of each patient were analysed and compared with their coronary angiograms by two experienced radiologists and one cardiologist who were unaware about the study, and the sensitivity of MDCT was determined. RESULTS: Twenty-three patients (age range 28-73) with seven different coronary arteries of the anomalous type were evaluated. Nineteen patients had an anomalous left coronary artery; three patients had an anomalous single coronary artery; and one patient had an anomalous right coronary artery. The most common anomaly type was the left circumflex coronary artery (52%). The origin and course of all anomalous vessels were detected by ECG-gated MDCT (Lightspeed 16, GE Medical Systems, Milwaukee, Wisconsin, USA). The sensitivity of 100% of MDCT was detected in patients who had anomalous coronary vessels. CONCLUSION: We suggest that MDCT could be a non-invasive alternative imaging technique to conventional coronary angiography for screening the anomalous vessels of coronary arteries because of its excellent spatial resolution, which is very important for detecting the relationship of anomalous vessels with great arteries and cardiac structures.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Estudos de Coortes , Angiografia Coronária , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Serum gamma-glutamyl transferase (GGT) activity, an enzyme responsible for the extracellular catabolism of antioxidant glutathione, may directly take part in atherogenesis and evolve as a potential biochemical risk indicator of cardiovascular morbidity and mortality. An important characteristic of coronary artery ectasia (CAE) is the fact that in 85% of the cases, atherosclerotic coronary disease accompanies it. The relation between CAE and serum GGT activity has not been studied so far. Hence, we decided to investigate the serum GGT level in patients with CAE. METHODS: We measured serum GGT activity in 88 consecutive patients (48 males) with isolated CAE and 86 patients with coronary artery disease (CAD) and 84 controls. CAE was defined as being without any stenotic lesions with a visual assessment of the coronary arteries showing a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. Four subgroups were created in accordance with the CAE extension in coronary arteries. RESULTS: There were no statistically significant differences in serum GGT activity among CAE and CAD groups. Serum GGT activity was found significantly increased in patients in both CAE and CAD groups, compared with those in control group (P<0.001, P<0.001, respectively). According to the CAE severity, there were no statistically significant differences in CAE among these subgroups. CONCLUSION: We have shown for the first time that patients with CAE have higher serum GGT activity compared with controls with normal coronary angiograms. Hence, serum GGT activity can be used as a follow-up marker in patients with CAE.
Assuntos
Doença da Artéria Coronariana/enzimologia , Vasos Coronários/patologia , gama-Glutamiltransferase/sangue , Adulto , Biomarcadores/sangue , Constrição Patológica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Dilatação Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Regulação para CimaRESUMO
BACKGROUND: Coronary angiography is the gold standard for diagnosing coronary artery fistulas (CAFs). Multidetector computed tomography (MDCT) is a recently developed imaging technique for detecting coronary artery stenosis, coronary artery anomalies, and coronary artery fistulas and their courses. OBJECTIVE: We aimed to determine accuracy or sensitivity of MDCT in patients having CAF. METHOD: We evaluated 13 patients with 15 CAFs detected earlier by coronary angiography. MDCT was carried out on all patients and the results were compared with coronary angiography, following which, sensitivity of MDCT was detected. RESULTS: Eleven of 15 CAFs were shown on MDCT and the overall sensitivity of MDCT was found to be 73%. Seven of 8 CAFs that coursed between two vascular structures were detected and the sensitivity of MDCT in this group was found to be 87%. However, the sensitivity of 58% of MDCT in patients with fistula coursing between coronary arteries and cardiac chambers was found. CONCLUSION: Although coronary angiography is the gold standard diagnostic test for detection of CAF, MDCT may be an alternative test, especially, for CAF coursing between vascular structures, to detect origin, course, and the drainage site of fistula through its excellent spatial resolution and ability to show relationship of anatomic structures.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Fístula Vascular/diagnóstico por imagem , Idoso , Angiografia Coronária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Although QRS-complex changes during ischemia have been described previously, their relation with no-reflow is not clear. PURPOSE: To evaluate relation of admission QRS duration with angiographic no-reflow, we studied 162 patients who underwent primary angioplasty. METHODS: Twelve-lead electrocardiogram with a paper speed of 50 mm/s was recorded on admission and repeated after angioplasty. Patients were divided into reflow and no-reflow groups based on postangioplasty coronary thrombolysis in myocardial infarction flow grade. RESULTS: Patients in the no-reflow group (26 patients) were older (P = .001) and had significantly longer pain-to-balloon interval (P = .007). The patients in the no-reflow group had significantly longer QRS duration on admission electrocardiogram compared with patients in the reflow group (interquartile range, 80-93 [median, 84] milliseconds vs 60-80 [median, 76] milliseconds, respectively; P < .001). After adjusting all variables, QRS duration on admission was found to be independently related to angiographic no-reflow (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P = .003). CONCLUSION: QRS duration on admission may be valuable in predicting no-reflow.
Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Eletrocardiografia/estatística & dados numéricos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Admissão do Paciente/estatística & dados numéricos , Angiografia Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prevalência , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Turquia/epidemiologiaRESUMO
OBJECTIVE: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey. METHODS: A burden-of-disease model was developed that included inputs on population growth, prevalence, and incidence of ischemic disease (IHD) and cerebrovascular disease (CeVD), prevalence of modifiable risk factors, mortality rates, and relationship between risk factors and IHD/CeVD. Direct costs to the public health-care system and indirect costs from lost production due to premature mortality, hospitalizations, disability, and absenteeism were considered. RESULTS: We estimated that in 2016, 3.4 million Turkish adults were living with CVD, including 2.5 million affected by IHD, and 0.9 million by CeVD. This prevalence is projected to increase to 5.4 million by 2035. The economic burden of CVD was estimated at US$10.2 billion in 2016, projected to increase twofold to US$19.4 billion by 2035. CONCLUSION: Our study confirms that the current burden of CVD is significant, and that it is projected to increase at a steep rate over the next two decades. This growing burden of disease will likely create significant pressure on the public health-care system in the form of direct health-care costs, as well as on society in the form of lost productivity.
Assuntos
Doenças Cardiovasculares/epidemiologia , Absenteísmo , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etiologia , Feminino , Custos de Cuidados de Saúde , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Turquia/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Mean platelet volume (MPV), a marker for platelet reactivity, and white blood cell count (WBC-C), a marker for inflammation, have been shown to be predictive of unfavourable outcomes among survivors of ST elevation myocardial infarction (STEMI). The relationship of admission MPV and WBC-C with infarct-related artery (IRA) patency is not clear. We aimed to evaluate the value of admission MPV and WBC-C for the prediction of IRA patency, in patients with acute STEMI treated with primary percutaneous coronary intervention. METHODS: Blood samples were obtained on admission in 351 STEMI patients. The patients who had thrombolysis in myocardial infarction (TIMI) 3 flow in initial angiography constituted the IRA patent group and others having less than TIMI 3 flow constituted the IRA occluded group. RESULTS: In 16% of the patients, IRAs were found to be patent on initial angiography. Patients in the IRA occluded group had higher admission MPVs (9.3+/-1.2 vs. 8.6+/-1.3 fl, P<0.001) and higher WBC-C (13.3+/-4.8 vs. 11.0+/-2.9, P=0.002) compared with patients in the patent IRA group. In regression analysis, WBC-Cs [beta, 0.131; odds ratio (OR), 1.140; 95% confidence interval (CI), 1.043-1.245, P=0.004)] and MPV (beta, 0.519; OR, 1.680; 95% CI, 1.206-2.339, P=0.002) were found to be independent predictors of occluded IRA. The best cutoff value of MPV for predicting an occluded IRA was determined to be 8.55 fl with a sensitivity of 74% and a specificity of 60%. CONCLUSION: MPV and WBC-C at admission might be valuable in the prediction of IRA patency and in planning the need for adjunctive therapy to improve outcomes in patients with STEMI undergoing percutaneous coronary intervention.
Assuntos
Angioplastia , Contagem de Leucócitos , Infarto do Miocárdio/fisiopatologia , Admissão do Paciente , Grau de Desobstrução Vascular , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/cirurgiaRESUMO
Warfarin, an oral anticoagulant, is the therapy of choice to maintain anticoagulation. An individual requiring five- to 20-fold higher dosage than average for anticoagulation may be considered as having resistance to warfarin. In order to evaluate a subtherapeutic response to high-dose warfarin, the clinician must consider many possible causes of resistance, such as non-compliance, drug interactions, or pharmacokinetic changes. When these factors have been eliminated, an hereditary warfarin resistance might be considered responsible. The case is reported of a 49-year-old woman who received warfarin after mitral valve replacement and experienced mechanical mitral valve thrombosis due to inadequate anticoagulation, possibly caused by warfarin resistance.
Assuntos
Anticoagulantes , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Estenose da Valva Mitral/cirurgia , Trombose/etiologia , Varfarina , Anticoagulantes/sangue , Anticoagulantes/uso terapêutico , Bioprótese , Resistência a Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Estenose da Valva Mitral/diagnóstico por imagem , Reoperação , Trombose/diagnóstico por imagem , Trombose/cirurgia , Ultrassonografia , Varfarina/sangue , Varfarina/uso terapêuticoRESUMO
OBJECTIVE: Hypertrophic cardiomyopathy (HCM) as a common genetic heart disease characterized by ventricular hypertrophy and myocardial fibrosis is significantly associated with a higher risk of fatal ventricular arrhythmic events (VAEs). We aimed to assess the interval between the peak and the end of the electrocardiographic T wave (Tp-e) and Tp-e/corrected QT (QTc) ratio as candidate markers of ventricular arrhythmias in patients with HCM. METHODS: In this single-center, prospective study, a total of 66 patients with HCM and 88 controls were enrolled. The patients were divided into two groups: those with VAEs (n=26) and those without VAEs (n=40). Tp-e interval and Tp-e/QTc ratio were measured using a 12-lead electrocardiogram. RESULTS: Tp-e interval was significantly longer and Tp-e/QTc ratio were significantly higher in HCM patients than in the controls. In correlation analysis, maximal left ventricular (LV) thickness also has a significant positive correlation with Tp-e interval (r=0.422, p<0.001) and Tp-e/QTc ratio (r=0.348, p<0.001). Finally, multivariable regression analysis showed that a history of syncope, Tp-e interval [OR (odds ratio): 1.060; 95% confidence interval (CI): 1.005-1.117); p=0.012], Tp-e/QTc ratio (OR: 1.148; 95% CI: 1.086-1.204); p=0.049], and maximal LV thickness were independent predictors of VAEs in patients with HCM. CONCLUSION: Our findings suggested that prolonged Tp-e interval and increased Tp-e/QTc ratio may be good surrogate markers for the prediction of VAEs in HCM.
Assuntos
Arritmias Cardíacas/diagnóstico , Cardiomiopatia Hipertrófica , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Ventrículos do Coração , Arritmias Cardíacas/fisiopatologia , Biomarcadores , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
OBJECTIVE: Transradial access is widely used for both diagnostic and interventional cardiac procedures. The use of transradial access offers several advantages, including decreased bleeding, fewer vascular complications, and reduced length of hospital stay and cost. However, the small size of the radial artery limits the size of the equipment that can be used via this approach. In this study we sought to investigate whether preprocedural manual heating of the radial artery facilitates radial artery puncture. METHODS: Patients undergoing transradial cardiac catheterization were randomized to subcutaneous nitroglycerin plus diltiazem or manual heating. The study endpoint was puncture score (score 1: easiest - puncture at first attempt; score 2: second attempt; score 3: third attempt; score 4: fourth attempt or more; score 5: puncture failed). RESULTS: Ninety consecutive patients were enrolled in the study, 45 allocated to the drug treatment group and 45 to the heating group. Patients underwent radial artery ultrasound before catheterization. Complications were rare: one hematoma (drug treatment group) and one radial artery occlusion (heating group). Baseline demographic and clinical characteristics were similar. Baseline radial artery diameter was similar in both groups (2.41±0.46 mm and 2.29±0.48 mm in the heating and drug treatment groups, respectively). However, the median puncture score was lower in the heating group (1; interquartile range 1-2) compared to the drug treatment group (2; interquartile range 1-3; p=0.001). CONCLUSIONS: Preprocedural manual heating of the radial artery facilitates radial artery puncture in patients undergoing transradial cardiac catheterization.