Remote patient monitoring after cardiac surgery: The utility of a novel telemedicine system.

OBJECTIVE: We examined cardiac surgery patients who underwent monitoring of postoperative vital parameters using medical monitoring devices which transferred data to a mobile application and a web-based software. METHODS: From November 2017 to November 2020, a total of 2340 patients were enrolled in the remote patient monitoring system after undergoing cardiac surgery. The medical devices recorded vital parameters, such as blood pressure, pulse rate, saturation, body temperature, blood glucose, and electrocardiography were measured via the Health Monitor DakikApp and Holter ECG DakikApp devices which reported data to web-based software and a mobile application (DakikApp Mobile Systems, Remscheid, Germany). During the follow-up period, patients were contacted daily through text and voice messages, and video conferences. Remote Medical Evaluations (RMEs) concerning patients' medical states were performed. Medication reminders, daily treatment were communicated to the patients with the DakikApp Mobile Systems Software. RESULTS: During a mean follow-up period of 78.9 ± 107.1 (10-395) days, a total of 135,786 patient contacts were recorded (782 video conferences, 2805 voice messaging, and 132,199 text correspondence). The number of RMEs handled by the Telemedicine Team was 79,560. A total of 105,335 vital parameter measurements were performed and 5024 hospital application requests (6.3% per RME) were addressed successfully and hospitalization was avoided. A total of 144 (6.1%) potentially life-threatening complications were found to have been diagnosed early using the Telemedicine System. CONCLUSION: Remote Patient Monitoring Systems combined with professional medical devices are feasible, effective, and safe for the purpose of improving postoperative outcomes.

Value of cardiopulmonary exercise testing in the diagnosis of coronary artery disease.

INTRODUCTION: Respiratory and cardiac functions in association with skeletal and neurophysiologic systems can be evaluated with cardiopulmonary exercise testing (CPET). Compared to treadmill exercise test, CPET provides more comprehensive data about the hemodynamic response to exercise. MATERIALS AND METHODS: We aimed to evaluate the relationship with CPET findings and coronary lesions identified on angiography in patients with angina pectoris who underwent teradmill exercise, CPET and coronary angiography (CAG). By this way we sought to examine the CPET parameters that might be predictive for coronary artery disease (CAD) before diagnostic exercise test results and ischemia symptoms develop. Thirty patients in whom CAG was planned because of symptoms and exercise test results were enrolled in the study. Oxygen consumption (VO2), carbondioxide production (VCO2), minute ventilation (VE), maximum work rate (WR), DVO2/DWR and O2 pulse (VO2/HR) values were calculated. Significant CAD was defined as ≥ 50% narrowing in at least one of the coronary arteries. RESULT: The mean age was 60.4 ± 8.9 years ve 21 (65.6%) of subjects were male. On CAG, CAD was detected in 19 (59.4%) patients. Maximum heart rate, heart rate reserve (HRR), VE/VCO2 measured at anaerobic threshold (AT) and VO2(mL/kg/min) were significantly differed in patients with CAD than those without (p= 0.031; p= 0.041; p= 0.028; p= 0.03 respectively). Peak VO2, VO2/WR and O2 pulse values were higher in patients with normal angiographic results than those with CAD but the difference did not reach to statistical significance. CONCLUSIONS: The findings of our study indicate that among CPET parameters AT VE/VCO2, ATVO2 (mL/kg/dk) and HRR can have predictive value in the diagnosis of CAD. We think that these parameters might be used in the evaluation of patients with angina and dyspnea suspected of CAD. In conclusion parameters obtained during the test that are not influenced by patient's effort might increase the value of CPET in the diagnosis CAD.

Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies.

BACKGROUND: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. METHODS AND RESULTS: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase ≥3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). CONCLUSIONS: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.

Coronary flow reserve in patients with diabetes mellitus and prediabetes.

BACKGROUND: Abnormalities of coronary microcirculation have been reported in patients with diabetes mellitus (DM) even in the presence of normal coronary arteries. It is unknown when the microvascular effects on coronary arteries begin to appear in the DM disease course. Coronary flow reserve (CFR), determined by pharmacological stress transthoracic Doppler echocardiography, is a reliable indicator of coronary microvascular function. We sought to determine the coronary microvascular function of prediabetic patients compared to DM patients and normal population. METHODS: Seventy-four subjects with normal coronary arteries were enrolled. DM and prediabetes were diagnosed according to American Diabetes Association criteria. All subjects had Doppler recordings of the left anterior descending artery with adenosine infusion at a rate of 0.014 mg/kg per minute. RESULTS: The demographical characteristics and laboratory findings of the three groups were similar (DM group: n = 25, mean age 62 ± 7 years, 19 females; prediabetic group: n = 25, mean age 64 ± 12 years, 21 females; control group: n = 24, mean age 63 ± 7 years, 15 females) except fasting glucose levels. CFR values of the three groups were significantly different (DM group: CFR = 1.75 ± 0.50; prediabetic group: CFR = 2.24 ± 0.43; control group: CFR = 2.38 ± 0.32, P < 0.001). CFR values of DM group were lower than those of prediabetic and control groups (DM vs. prediabetic: P < 0.001, DM vs. control: P < 0.001). However, CFR levels of prediabetic group were not different from those of the control group (P = 0.481). DM was an independent factor predictive of CFR < 2 (OR, 22.69; 95% CI, 6.47-79.51; P < 0.001). CONCLUSION: Coronary microvascular function seems to be normal in the prediabetic state, but dysfunction appears after DM becomes overt.

Association between cardiac functional capacity and parameters of tissue Doppler imaging in patients with normal ejection fraction.

OBJECTIVE: Patients with normal ejection fraction (EF) by conventional echocardiography may present with symptoms and findings of decreased cardiac functional capacity. We aimed to investigate the association between cardiac functional capacity determined by cardiopulmonary exercise test (CPET) and parameters of tissue Doppler (TD) imaging in patients with normal EF. METHODS: In all, 52 patients with normal EF were included. Conventional and TD imaging were performed. Peak systolic (S), early (E') and late (A') diastolic velocities were obtained from septal and lateral mitral annulus and tricuspid annulus by pulsed-wave TD. CPET was performed. Exercise time, peak oxygen consumption (peak VO2), anaerobic threshold (AT), metabolic equivalents (MET) values were determined and were compared with TD imaging parameters. RESULTS: We did not find any association between conventional echocardiographic measurements and cardiac functional capacity. However, peak S, E' and A velocity from the septal and tricuspid annulus and E' velocity from the lateral annulus correlated with exercise time, peak VO2, AT and MET (all P < 0.05). E/E' from the left ventricle correlated inversely with exercise time, peak VO2, AT and MET (all P < 0.05). S, E, A' velocities from septal and tricuspid annulus, E' velocity from lateral annulus were lower in patients with MET < or = 7 than in patients with MET > 7 (all P < 0.05). CONCLUSION: Systolic and diastolic velocities measured byTD imaging correlated with cardiac functional capacity as determined by CPET in patients with normal EF by conventional echocardiography. TD imaging could be more susceptible to determine cardiac functional capacity in these patients.

Increased serum gamma-glutamyltransferase activity in patients with metabolic syndrome.

OBJECTIVES: Accumulating data indicate that serum gamma-glutamyltransferase (GGT) activity represents a true marker of atherosclerotic cardiovascular disease and has prognostic importance. In this study, we sought to evaluate serum GGT activity in patients with metabolic syndrome (MetS). STUDY DESIGN: We enrolled 232 patients (mean age 60.4 years) from our outpatient cardiology clinic, 117 with and 115 without MetS (control group) as defined by the ATP-III criteria. The results of serum liver function tests including serum GGT and C-reactive protein (CRP) levels were compared between the two groups. RESULTS: The two groups were similar with regard to age, sex, smoking, and family history of coronary artery disease (p>0.05). The prevalences of hypertension and dyslipidemia were significantly higher in patients with MetS. Compared with controls, patients with MetS had significantly higher serum GGT [(median 21, interquartile range (16-33) vs. 19 (14-26) U/l; p=0.008] and C-reactive protein levels [6.2 (3.6-9.4) vs. 5.0 (3.1-7.0) U/l; p=0.044]. A high GGT activity (>40 U/l) was determined in 14.5% of the patients with MetS and in 4.4% of the control subjects (p=0.012). Serum GGT level showed significant correlations with MetS (r=0.24, p=0.001), CRP (r=0.20, p=0.003), triglyceride (r=0.18, p=0.006), HDL cholesterol (r=-0.19, p=0.004), aspartate aminotransferase (r=0.15, p=0.02), alanine aminotransferase (r=0.32, p=0.001), and alkaline phosphatase (r=0.16, p=0.01). This significant association continued only for MetS (ß=-0.25, p=0.03), HDL cholesterol (ß=-0.18, p=0.03), and alkaline phosphatase (ß=0.17, p=0.01) in multivariate regression analysis. CONCLUSION: Our findings suggest that patients with MetS have higher serum GGT and CRP levels compared with controls. This increased GGT level might be a marker of increased oxidative stress and premature atherosclerosis.

Platelet function analysis with two different doses of aspirin.

OBJECTIVES: We aimed to compare the level of platelet inhibition using the platelet function analyzer (PFA)-100 in patients receiving low and medium doses of aspirin. STUDY DESIGN: On a prospective basis, 159 cardiology outpatients (83 men, 76 women; mean age 60.9 ± 9.9 years) taking 100 mg/day or 300 mg/day aspirin at least for the previous 15 days were included. Of these, 79 patients (50%) were on 100 mg and 80 patients (50.3%) were on 300 mg aspirin treatment. Blood samples were collected between 09:30 and 11:00 hours in the morning. Platelet reactivity was measured with the PFA-100 system. Incomplete platelet inhibition was defined as a normal collagen/epinephrine closure time (< 165 sec) despite aspirin treatment. RESULTS: Baseline clinical and laboratory characteristics of the patient groups taking 100 mg or 300 mg aspirin were similar. The overall prevalence of incomplete platelet inhibition was 22% (35 patients). The prevalence of incomplete platelet inhibition was significantly higher in patients treated with 100 mg of aspirin (n = 24/79, 30.4%) compared with those treated with 300 mg of aspirin (n = 11/80, 13.8%) (p = 0.013). In univariate analysis, female sex (p = 0.002) and aspirin dose (p = 0.013) were significantly correlated with incomplete platelet inhibition. In multivariate analysis, female sex (OR: 0.99; 95% CI 0.9913-0.9994; p = 0.025) and aspirin dose (OR: 3.38; 95% CI 1.4774-7.7469; p = 0.003) were found as independent factors predictive of incomplete platelet inhibition. CONCLUSION: Our findings suggest that treatment with higher doses of aspirin can reduce incomplete platelet inhibition especially in female patients.

Association of serum adiponectin levels and coronary flow reserve in women with normal coronary angiography.

BACKGROUND: Women may have atypical clinical presentations and atypical risk factors of coronary artery disease. Adiponectin has anti-insulin-resistant properties and antiatherogenic effects. We investigated the association between serum adiponectin levels and coronary flow reserve (CFR) in women with normal coronary arteries. METHODS: CFR was assessed in 45 consecutive women (mean age 54.2+/-9.2 years) with normal epicardial coronary arteries by coronary angiography. Serum adiponectin, C-reactive protein, insulin, and glucose levels were examined and Homeostasis Model Assessment for Insulin Resistance index was calculated. Peak diastolic coronary flow velocities were measured in distal left anterior descending artery at baseline and after dipyridamole infusion by transthoracic pulsed wave Doppler echocardiography. CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities. A CFR value > or =2 was accepted as normal. RESULTS: Adiponectin levels were lower in patients with impaired CFR than those with normal CFR (7.1+/-2.3 vs. 13.8+/-6.7 microg/ml P<0.001). Adiponectin levels were correlated with CFR (r=0.531, P<0.001) and inversely correlated with C-reactive protein (r=-0.308, P=0.047), insulin (r=-0.426, P=0.008), and Homeostasis Model Assessment for Insulin Resistance index (r=-0.442, P=0.004). Adiponectin levels of < or =8.5 muU/ml had 83% sensitivity and 93% specificity [receiver operating characteristic area 0.084, P<0.001, 95% confidence interval (0.56-1.08)] for predicting impaired CFR. CONCLUSION: Decreased adiponectin levels are associated with impaired CFR in women with normal epicardial coronary arteries and hypoadiponectinemia may be a risk factor for impaired CFR in women.

Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Hemodynamic changes caused by carbon dioxide (CO(2)) insufflation occur frequently in patients who undergo laparoscopic surgery. One indicator of these changes is corrected QT dispersion (QTcd), an index of myocardial function. Prolongation of QTcd has been associated with cardiovascular morbidity and mortality. We compared the effects of high-pressure (15 mmHg) and low-pressure (7 mmHg) CO(2) pneumoperitoneums on the QT interval, the rate-corrected QT interval (QTc), the QT dispersion (QTd), and the corrected QT dispersion (QTcd) during laparoscopic cholecystectomy. METHODS: Twenty consecutive patients were in a low-pressure pneumoperitoneum group and 32 were in a high-pressure pneumoperitoneum group. A 12-lead electrocardiogram was used to monitor cardiac variables. In all patients, serial electrocardiograms were recorded before anesthesia induction (baseline), immediately after the pneumoperitoneum had been created, every 15 minutes during CO(2) insufflation, and 5 minutes after deflation. Two observers measured the QT intervals independently, and the QTcd was calculated using Bazett's formula. RESULTS: The QT interval and the QTc interval did not change significantly during the study in either group. The QTd and QTcd in the high-pressure pneumoperitoneum group increased significantly during CO(2) insufflation and were significantly higher in the high-pressure pneumoperitoneum group compared with the low-pressure pneumoperitoneum group. Changes caused by CO(2) insufflation were reversible. CONCLUSIONS: Statistically significant increases of QTd and QTcd, which are associated with an increased risk of arrhythmias and cardiac events, occur during CO(2) insufflation in both high-pressure and low-pressure pneumoperitoneums. QTd and QTcd were significantly higher in the high-pressure pneumoperitoneum group than they were in the low-pressure pneumoperitoneum group. QT interval changes were not related to anesthetic agents, surgical stress, hypercapnia, or duration of CO(2) insufflation. Increased intra-abdominal pressure may have caused these changes.

Serum levels of C-reactive protein and uric acid in patients with cardiac syndrome X.

OBJECTIVES: Angina-like chest pain, a positive result from a stress test, and normal coronary arteries are characteristics of patients with cardiac syndrome X (CSX). Serum levels of C-reactive protein (CRP), which is a marker of a systemic inflammatory state, are associated with coronary atherosclerosis and endothelial dysfunction. Serum uric acid (UA) levels have also been implicated in the development of atherosclerotic cardiovascular disease. However, little is known about the association of serum UA and CRP levels with CSX. METHODS: In all, 250 subjects (100 patients with CSX, 100 with coronary artery disease (CAD), and 50 control subjects) were enrolled in the study. Coronary arteries were evaluated by conventional coronary angiography in the CSX and CAD groups. All patients underwent a noninvasive stress test. To determine whether they are potential risk factors for CSX, serum CRP and UA levels were compared among the 3 groups. RESULTS: Serum levels of CRP were higher in patients with CSX or CAD than in the control subjects (4.4 +/- 3.1 and 4.5 +/- 2.9 mg/L, respectively, vs. 1.9 +/- 1.6 mg/L; P < 0.001), but those levels were similar in patients with CSX or CAD. Uric acid levels were higher in patients with CSX or CAD than in the control subjects (5.5 +/- 1.1 mg/dl and 5.9 +/- 1.4 mg/dl, respectively, vs. 4.4 +/- 1.2 mg/dl; P < 0.00 1), but those levels were also similar in patients with CSX or CAD. CONCLUSIONS: In patients with CSX, serum CRP and UA levels were as high as those in patients with CAD. Elevated serum CRP and UA levels may contribute to the development of CSX.

Decreased coronary flow reserve in obese women.

OBJECTIVES: Obesity is associated with an increased rate of cardiovascular disease and risk factors. It is a common problem in apparently healthy women. We aimed to investigate the association between obesity and coronary flow reserve (CFR) in obese women. STUDY DESIGN: The study included 80 consecutive women (mean age 55.6+/-10.2 years) without diabetes mellitus and clinical coronary artery disease. Body mass index (BMI) was calculated and obesity was defined as BMI = or >30 kg/m(2). Based on BMI, the patients were grouped as normal weight (n=13; 18.5-24.9 kg/m(2)), overweight (n=32; 25-29.9 kg/m(2)), obese (n=32; = or >30-39.9 kg/m(2)), and morbid obese (n=3; = or > 40 kg/m(2)). Peak diastolic coronary flow velocities were measured in the distal left anterior descending artery by transthoracic pulsed wave Doppler echocardiography at baseline and after dipyridamole infusion and CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities. RESULTS: There were 35 obese women (43.8%). Coronary flow reserve was significantly lower in obese women than in nonobese subjects (2.2+/-0.5 vs. 2.5+/-0.4; p=0.022). The lowest CFR was seen in patients with a BMI of = or > 40 kg/m(2); overweight women did not differ significantly from women of normal weight. Coronary flow reserve was correlated with BMI (r=-0.314, p=0.005), waist circumference (r=-0.316, p=0.005), C-reactive protein (CRP) (r=-0.342, p=0.011), and adiponectin level (r=0.410, p=0.011). In regression analysis, BMI (p=0.017), waist circumference (p=0.048), systolic blood pressure (p=0.025), fasting glucose (p=0.035), and adiponectin level (p=0.037) were found to be independent predictors for impaired CFR. In ROC analysis, the cut-off value for BMI to predict impaired CFR was = or > 30 kg/m(2), with 76% sensitivity and 72% specificity (ROC area 0.805, p<0.001, 95% CI 0.669-0.96). CONCLUSION: Impaired CFR in obese women suggests the presence of microvascular dysfunction. Treatment of obesity is important for the prevention of atherosclerosis.

Serum gamma-glutamyl transferase activity: new high-risk criteria in acute coronary syndrome patients?

In acute coronary syndromes (ACS), oxidation and inflammation have very important roles and in-vitro studies have demonstrated that gamma-glutamyl transferase (GGT) participates in such oxidative and inflammatory reactions. We aimed to evaluate the prognostic value of baseline serum GGT activity on the development of major adverse cardiac event (MACE) in the follow-up of the patients with ACS in coronary care unit (CCU), after 1 and 6 month periods. We included 117 patients (mean age: 61.2+/-11.3 years, 93 males) hospitalized in CCU with the diagnosis of ACS. All had baseline serum GGT activity and were free of systemic and hepatobiliary disease. MACE was defined as the composite of mortality from cardiac causes, recurrent hospitalization with ACS and nonfatal recurrent myocardial infarction diagnoses, to need for coronary revascularization during CCU, over 1 and 6 month follow-up periods. During the follow-up of CCU, MACE occurred in 17 (14.5%) patients (two died). Serum GGT activity was significantly higher in the patients with MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-CCU [relative hazard: 1.05, 95% confidence interval (CI): 1.01-1.09, P=0.007]. During the follow-up of 1 month, MACE occurred in 23 (20.0%) patients (five died). Serum GGT activity was significantly higher in patients with MACE than those free of MACE (P=0.021) and GGT was found as the independent predictor of the development of MACE-1 month (relative hazard: 1.04, 95% CI: 1.01-1.08, P=0.039). During the follow-up of 6 months, MACE occurred in 24 (21.8%) patients (two died). Again, GGT was significantly higher in patients who developed MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-6 months (relative hazard 1.06, 95% CI: 1.03-1.10, P<0.001). Serum GGT activity was found to be an independent predictor of the development of MACE in the patients with ACS during CCU, over 1 and 6 month follow-up periods.

Echocardiographic diagnosis of left ventricular-right atrial communication (Gerbode-type defect) in an adult with chronic renal failure: a case report.

Left ventricular-right atrial communication, known as a Gerbode-type defect, is a rare form of ventricular septal defect. It is usually congenital, but rarely acquired. Clinical presentation is associated with the volume of the shunt. Transthoracic echocardiography is the most useful diagnostic method. We present a 63-year-old man with chronic renal failure and left ventricular-right atrial shunt.

Serum gamma-glutamyltransferase activity is increased in patients with calcific aortic valve stenosis.

BACKGROUND AND AIM OF THE STUDY: A growing body of data indicates an independent association between serum gamma-glutamyltransferase (GGT) activity, a marker of increased oxidative stress, and cardiovascular diseases. The process of calcific aortic valve disease has been shown to present characteristics of atherosclerosis. The study aim was to evaluate the possible role of serum GGT in patients with calcific aortic valve disease. METHODS: The results of patients' echocardiography studies from 2005 for the presence of calcific aortic valve disease in the forms of aortic stenosis (AS) and aortic valve calcification (AVC) without significant valve stenosis, were retrospectively evaluated. Age-and gender-matched patients with normal aortic valve morphology were selected at random as a control group. A total of 383 patients was enrolled into the study (126 with AS, 133 with AVC, 124 controls). Serum GGT activity, along with other liver enzyme analyses and laboratory results, were determined and compared among the groups. RESULTS: Age, gender and clinical and laboratory results were similar among the three groups. Median serum GGT levels in the AS, AVC and control groups were 23.0 U/1 (mean 31.5 +/- 24.9 U/1), 22.0 U/1 (mean 27.6 +/- 18.6 U/) and 18.0 U/l (mean 22.4 +/- 16.4 U/l), respectively. Compared to controls, AS patients had significantly higher serum GGT and C-reactive protein levels, while the differences between AVC patients and controls for these parameters were not significant. CONCLUSION: The study results suggest that serum GGT activity is increased in patients with calcific AS. These increases seem to occur in advanced rather than milder forms of calcific aortic valve disease.

Comparison of C-reactive protein levels in patients who do and do not develop atrial fibrillation during electrophysiologic study.

C-reactive protein (CRP) was increased in patients with atrial fibrillation (AF). The aim of this study was to evaluate CRP after inducing AF in 39 patients undergoing electrophysiologic study (EPS). After a diagnostic EPS, programmed atrial stimulation with 3 extra stimuli from the right atrium was performed in all patients. CRP was measured before and 6 and 24 hours after the procedure. Patients in whom AF was induced were monitored for 24 hours. AF was induced in 18 of 39 patients. Twenty-one patients without a tachyarrhythmia constituted the control group. Groups were similar with regard to age, gender, incidences of hypertension and diabetes, and history of coronary artery disease. On average, AF lasted 4.8 hours, and spontaneous conversion to sinus rhythm was observed in all patients. There were no statistically significant differences with respect to baseline and 6-hour CRP values between groups. However, mean CRP at 24 hours was significantly higher in patients with AF compared with controls (10 +/- 11 and 3.9 +/- 4.2 mg/L; p = 0.04). In conclusion, induction of AF during EPS led to increased CRP. This finding suggested that increased CRP may be the consequence of AF.

Effects of serum levels of novel atherosclerotic risk factors on aortic valve calcification.

BACKGROUND AND AIM OF THE STUDY: Aortic valve calcification (AVC) is a common condition that is found predominantly in the elderly. Clinical and histopathologic data prove that AVC is an active, progressive disease involving an atherosclerotic process. The possible role of novel coronary risk factors in the development of AVC were evaluated. METHODS: A total of 285 consecutive patients (age >60 years) who had been admitted to the authors' cardiology outpatient clinic was enrolled. Each patient underwent two-dimensional Doppler echocardiography. Serum levels of lipoprotein(a) (Lp(a)), homocysteine (Hcy), uric acid and C-reactive protein (CRP) were monitored and compared between patients with AVC and subjects with otherwise normal aortic valve morphology. RESULTS: AVC was detected in 112 patients. Compared to controls, patients with AVC were significantly older (73.0 +/- 7.4 versus 68.5 +/- 6.7 years; p <0.0001) and, in addition to higher dyslipidemia, had significantly higher serum levels of Lp(a) (27.4 (range: 13.0-47.5) versus 19.9 (range: 10.7-36.1) mg/dl; p = 0.033) and CRP (6.7 (4.5-10.2) versus 5.6 (3.9-8.0) mg/l; p = 0.008). Serum Hcy and uric acid levels were similar between the groups. Multivariate analysis identified age and serum levels of Lp(a) or CRP as independent determinants of AVC. CONCLUSION: AVC is common in elderly patients admitted to cardiology clinics. In addition to advanced age, high serum levels of Lp(a) and CRP are independent predictors of the condition.

Does pravastatin therapy affect cardiac enzyme levels after percutaneous coronary intervention?

Serum cardiac enzyme elevation after percutaneous coronary intervention (PCI), a relatively common complication, is a prognostic determinant of long-term outcome in patients who undergo these procedures. Statins are postulated to reduce such complications. This study investigated the short-term effects of pravastatin on serum creatine kinase myocardial isoform (CK-MB) and serum cardiac troponin I (cTpI) levels after elective PCI. Of 93 patients studied, 72 (77.4%) were men, and 21 (22.6%) were women (mean age, 58.9+/-11.0 y). Patients were randomly divided into 3 groups before they underwent elective PCI. Preoperatively, group 1 patients (n=30) received pravastatin 10 mg/d, and group 2 patients (n=29) received pravastatin 40 mg/d. Control group patients (n=34) received no lipid-lowering medication. Serum CK-MB and serum cTpI levels were measured preoperatively and then again at 6, 24, and 36 h postoperatively. Demographic features of patients and characteristics of the PCI procedure, including number of vessels/lesions and duration and number of inflations, did not differ among groups (P>.05). Mean serum CK-MB and serum cTpI levels were significantly increased after PCI in all patients (P<.001). When compared with control group patients, those given pravastatin did not experience significantly lowered postprocedural serum CK-MB or serum cTpI levels (P>.05). Preprocedural pravastatin therapy at dosages of 10 mg/d and 40 mg/d seems inadequate for preventing serum cardiac enzyme elevations during short-term follow-up after PCI. Additional research on this topic is recommended.

Efficacy of catheter ablation of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy.

BACKGROUND: Although pulmonary vein (PV) antrum isolation is effective in curing atrial fibrillation (AF) in a variety of heart diseases, results in patients with hypertrophic obstructive cardiomyopathy (HOCM) have not been reported. OBJECTIVES: The purpose of this study was to report the results and outcome of PV antrum isolation in patients with AF and HOCM. METHODS: Data from patients with AF and HOCM who underwent PV antrum isolation between February 2002 and May 2004 were analyzed retrospectively. An intracardiac echocardiographic-guided ablation technique with an 8-mm-tip catheter was used in all patients. Patients were followed in the outpatient clinic at 3, 6, and 12 months after ablation. RESULTS: Twenty-seven patients with AF and HOCM (mean age 55 +/- 10 years) underwent PV antrum isolation. Mean AF duration was 5.4 +/- 3.6 years. AF was paroxysmal in 14 (52%), persistent in 9 (33%), and permanent in 4 (15%). During a mean follow-up of 341 +/- 237 days, 13 patients (48%) had AF recurrence. Of these patients, five maintained sinus rhythm (SR) with antiarrhythmic drugs, one patient remained in persistent AF, and seven patients underwent a second PV antrum isolation. After the second PV antrum isolation, five patients remained in SR, giving a final success rate of 70% (19/27). Two patients had recurrence after second PV antrum isolation; one maintained SR with antiarrhythmic drugs and one remained in persistent AF. CONCLUSION: Compared with previously reported results in patients with lone AF, AF recurrence after the first PV antrum isolation is higher in patients with HOCM. However, after repeated ablation procedures, long-term cure can be achieved in a sizable number of patients. PV antrum isolation is a feasible therapeutic option in patients with AF and HOCM.

Frequency of atrial fibrillation and factors related to its development in dialysis patients.

BACKGROUND: The frequency of atrial fibrillation is increased in patients with end-stage renal disease. In this study, we sought to determine the incidence of persistent and paroxysmal atrial fibrillation in patients with end-stage renal disease and to identify the risk factors associated with this arrhythmia. METHODS: Two hundred seventy-five patients with end-stage renal disease who were in a hemodialysis program for at least 4 months were included in the study. Patients with permanent, persistent, or paroxysmal atrial fibrillation were identified and recorded. All patients were evaluated for cardiac risk factors and arrhythmias. RESULTS: Thirty (10.9%) of the 275 patients were found to have atrial fibrillation. Ten (33.3%) of these patients had permanent or persistent atrial fibrillation, and 20 (66.6%) of these patients had paroxysmal atrial fibrillation. Patients with atrial fibrillation were older. Incidences of hypertension, coronary artery disease, left ventricular systolic dysfunction, right atrial diameters, and mitral and/or aortic calcification were significantly higher in patients with atrial fibrillation. Serum albumin and high-density lipoprotein levels were significantly lower in patients with atrial fibrillation. CONCLUSIONS: Our data indicate that atrial fibrillation is a frequent arrhythmia in patients with end-stage renal disease, and the most frequently encountered form is paroxysmal atrial fibrillation. In this patient group, presence of coronary artery disease, age, and right atrial diameter are independent factors for determination of the risk of development of atrial fibrillation.