Prolonged hypotension after carotid artery stenting: incidence, predictors and consequences.

BACKGROUND: Hemodynamic changes frequently occur after carotid artery stenting (CAS), and in some patients these changes, particularly hypotension, may be prolonged. There are discrepant results for predicting patients at high risk for these prolonged hemodynamic changes and identifying the effect on clinical outcome. In this study, we aimed to determine the frequency, predictors and consequences associated with prolonged hypotension (PH) after CAS in our center. METHODS: We retrospectively analyzed the demographics, risk factors, nature of carotid disease, degree of stenosis of both internal carotid arteries, stent diameter and site of dilatation during stenting in 137 CAS procedures. After CAS, duration of hospital stay, complications during hospital stay and major vascular events or death in a 3-month period were evaluated. PH was defined as a systolic blood pressure <90 mmHg lasting more than 1 h despite adequate treatment after CAS. RESULTS: PH occured in 23 (16.8%) patients. The presence of contralateral stenosis ≥70% and absence of diabetes mellitus were significantly associated with PH. Duration of hospital stay was significantly longer in patients with PH. No patients with PH had a periprocedural complication or major vascular events in the follow-up period. CONCLUSION: PH was more prevalent in patients with contralateral high-degree carotid stenosis and patients without diabetes mellitus after CAS. PH did not cause any post-procedural complications or major vascular events at follow-up, but it resulted longer hospital stays. Further studies are needed to better define the pathophysiologic mechanisms underlying these hemodynamic alterations.

Transcatheter trans-apical closure of paravalvular mitral and aortic leaks using a new device: first in man experience.

This report describes the first use of a new paravalvular leak (PVL) device designed specifically to close paravalvular mitral and paravalvular aortic leaks. The first patient had severe paravalvular mitral leak that was closed using the transapical route with a rectangular designed PVL device that has an oval waist for self-centering and the second patient had moderate paravalvular aortic leak that was closed with a square designed device that has a round waist for self-centering. Both patients had complete closure.

Red cell distribution width predicts new-onset atrial fibrillation after coronary artery bypass grafting.

INTRODUCTION: Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of RDW in prediction of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG). We aimed to investigate the relation between the RDW and postoperative AF in patients undergoing CABG. METHODS: A total of 132 patients undergoing nonemergency CABG were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We retrospectively analyzed 132 consecutive patients (mean age, 60.55 ± 9.5 years; 99 male and 33 female). The RDW level was determined preoperatively and on postoperative Day 1. RESULTS: Preoperative RDW levels were significantly higher in patients who developed AF than in those who did not (13.9 ± 1.4 vs. 13.3 ± 1.2, p = 0.03). There was not any correlation between postoperative RDW levels and AF. Using a cutpoint of 13.45, the preoperative level correlated with the incidence of AF with a sensitivity of 61% and specificity of 60%. CONCLUSION: Preoperative RDW level predicts new-onset AF after CABG in patients without histories of AF.

Prognostic significance of T-wave amplitude in lead aVR on the admission electrocardiography in patients with anterior wall ST-elevation myocardial infarction treated by primary percutaneous intervention.

BACKGROUND: T-wave positivity in aVR lead patients with heart failure and anterior wall old ST-segment elevation myocardial infarction (STEMI) are shown to have a higher frequency of cardiovascular mortality, although the effects on patients with STEMI treated with primary percutaneous coronary intervention (PCI) has not been investigated. In this study, we sought to determine the prognostic value of T wave in lead aVR on admission electrocardiography (ECG) for in-hospital mortality in patients with anterior wall STEMI treated with primary PCI. METHODS: After exclusion, 169 consecutive patients with anterior wall STEMI (mean age: 55 ± 12.9 years; 145 men) undergoing primary PCI were prospectively enrolled in this study. Patients were classified as a T-wave positive (n = 53, group 1) or T-wave negative (n = 116, group 2) in aVR based upon the admission ECG. All patients were evaluated with respect to clinical features, primary PCI findings, and in-hospital clinical results. RESULTS: T-wave positive patients who received primary PCI were older, multivessel disease was significantly more frequent and the duration of the patient's hospital stay was longer than T-wave negative patients. In-hospital mortality tended to be higher in the group 1 when compared with group 2 (7.5% vs 1.7% respectively, P = 0.05). After adjusting the baseline characteristics, positive T wave remained an independent predictor of in hospital mortality (odds ratio: 4.41; 95% confidence interval 1.2-22.1, P = 0.05). CONCLUSIONS: T-wave positivity in lead aVR among patients with an anterior wall STEMI treated with primary PCI is associated with an increase in hospital cardiovascular mortality.

[Nephrotoxicity of iodixanol versus iopamidol in patients with acute coronary syndrome]. / Akut koroner sendromlu hastalarda iyodiksanol ile iyopamidolün nefrotoksik etkilerinin karsilastirmasi

OBJECTIVES: The iso-osmolar contrast agent iodixanol may be associated with fewer contrast-induced acute kidney injuries when compared with low-osmolar contrast agents. The aim of this study is to compare iodixanol and iopamidol in patients with acute coronary syndrome (ACS) who are currently undergoing coronary angiography. STUDY DESIGN: Two hundred and seventy five consecutive patients who presented to a tertiary cardiovascular center with acute non-ST elevation myocardial infarction and underwent coronary angiography as a part of an early invasive strategy were included in the study (mean age 58±11 years, 79% male). Study participants were administered either iodixanol (n=45) or iopamidol (n=230) and the groups were compared for the highest creatinine levels, the absolute and percent change in creatinine levels, and for the development of contrast induced nephropathy within 72 hours of the procedure. RESULTS: Baseline demographic and clinical characteristics of the patients were similar between the two groups. There were no differences in the preprocedural serum creatinine (iopamidol 1.10±0.54 mg/dl, iodixanol 1.09±0.24 mg/dl, p=0.680), glomerular filtration rate (iopamidol 89±35 ml/dk/1.73 m(2), iodixanol 89±26 ml/dk/1.73 m(2), p=0.934), or contrast volume used during the procedure (iopamidol 180±80 ml vs. iodixanol 166±73 ml, p=0.226) between the groups. The absolute change in serum creatinine after the procedure (iopamidol 0.136±0.346 mg/dl, iodixanol 0.072±0.070 mg/dl, p=0.118) and the percent change in serum creatinine after the procedure (iopamidol 12.1±29.6%, iodixanol 6.8±6.9%, p=0.075) were not statistically significant between the two groups. Contrast induced nephropathy developed 10% (95% confidence interval [CI] 6-14%) in iopamidol group whereas it was 2.2% (95% CI -2-7%) in iodixanol group (p=0.144). CONCLUSION: Iodixanol was not superior to iopamidol regarding contrast induced acute kidney injury after coronary angiography in an unselected general patient population with ACS.

Association of neutrophil to lymphocyte ratio with presence of isolated coronary artery ectasia.

OBJECTIVES: Coronary artery ectasia (CAE) has been defined as a dilated artery luminal diameter that is at least 50% greater than the diameter of the normal portion of the artery. Isolated CAE is defined as CAE without significant coronary artery stenosis and isolated CAE has more pronounced inflammatory symptoms. Neutrophil to lymphocyte ratio (NLR) is widely used as a marker of inflammation and an indicator of cardiovascular outcomes in patients with coronary artery disease. We examined a possible association between NLR and the presence of isolated CAE. STUDY DESIGN: In this study, 2345 patients who underwent coronary angiography for suspected or known ischemic heart disease were evaluated retrospectively. Following the application of exclusion criteria, our study population consisted of 81 CAE patients and 85 age- and gender-matched subjects who proved to have normal coronary angiograms. Baseline neutrophil, lymphocyte and other hematologic indices were measured routinely prior to the coronary angiography. RESULTS: Patients with angiographic isolated CAE had significantly elevated NLR when compared to the patients with normal coronary artery pathology (3.39 ± 1.36 vs. 2.25 ± 0.58, p<0.001). A NLR level >= 2.37 measured on admission had a 77% sensitivity and 63% specificity in predicting isolated CAE at ROC curve analysis. In the multivariate analysis, hypercholesterolemia (OR=2.63, 95% CI 1.22-5.65, p=0.01), obesity (OR=3.76, 95% CI 1.43-9.87, p=0.007) and increased NLR (OR=6.03, 95% CI 2.61-13.94, p<0.001) were independent predictors for the presence of isolated CAE. CONCLUSION: Neutrophil to lymphocyte ratio is a readily available clinical laboratory value that is associated with the presence of isolated CAE.

Patients with tombstoning pattern on the admission electrocardiography who have undergone primary percutaneous coronary intervention for anterior wall ST-elevation myocardial infarction: in-hospital and midterm clinical outcomes.

BACKGROUND: A tombstoning pattern (T-pattern) is associated with in-hospital poor outcomes patients with ST-segment elevation myocardial infarction (STEMI), but no data are available for midterm follow-up. We sought to determine the prognostic value of a T-pattern on admission electrocardiography (ECG) for in-hospital and midterm mortality in patients with anterior wall STEMI treated with primary percutaneous coronary intervention (PCI). METHODS: After exclusion, 169 consecutive patients with anterior wall STEMI (mean age: 55 ± 12.9 years; 145 men) undergoing primary PCI were prospectively enrolled in this study. Patients were classified as a T-pattern (n = 32) or non-T-pattern (n = 137) based upon the admission ECG. Follow-up to 6 months was performed. RESULTS: In-hospital mortality tended to be higher in the T-pattern group compared with non-T-pattern group (9.3% vs 2.1% respectively, P = 0.05). All-cause mortality was higher in the T-pattern group than non-T-pattern group for 6 month (P = 0.004). After adjusting the baseline characteristics, the T-pattern remained an independent predictor of 6-month all-cause mortality (odds ratio: 5.18; 95% confidence interval: 1.25-21.47, P = 0.02). CONCLUSION: A T-pattern is a strong independent predictor of 6-month all-cause mortality in anterior STEMI treated with primary PCI. Therefore, it may be an indicator of high risk among patients with anterior wall STEMI.

Clinical outcomes of primary angioplasty in ST elevation myocardial infarction patients with antecedent hypertension during hospital stay and follow-up.

Hypertension is a known risk factor for coronary artery disease. However, the number of studies focusing on the events following ST elevation myocardial infarction (STEMI) in patients with an antecedent hypertension is limited. Our aim is to evaluate the clinical outcomes of primary angioplasty in STEMI patients with antecedent hypertension during hospital stay and follow-up. A total of 373 patients (177 of whom had antecedent hypertension) who were treated by primary angioplasty because of STEMI were included in this study. All parameters were compared between the groups with and without hypertension. Hypertensive patients who received primary angioplasty were older (59.9 ± 12.6 vs. 52 ± 12.3, P < .001) and had higher rates of in-hospital mortality and major adverse cardiac events than patients without hypertension. Among STEMI patients, only history of hypertension for more than 10 years was a predictor of in-hospital mortality (odds ratio: 4.374, 95% CI 1.017-18.822, P = .04). Patients with an antecedent hypertension have higher initial risk profiles and show more negative outcomes during a 6-month follow-up period.

Relation of the metabolic syndrome with proarrhythmogenic electrocardiographic parameters in patients without overt diabetes.

OBJECTIVES: We aimed to observe the relationship of the metabolic syndrome and proarrythmogenic ECG parameters and to evaluate a possible correlation of these parameters to the metabolic syndrome score in patients without overt diabetes mellitus. METHODS: The study population consisted of 142 patients with the metabolic syndrome and 170 age- and gender-matched control subjects. In the ECG recordings, resting heart rate, QRS duration, corrected QT duration and corrected QT dispersion were measured. Patients were classified into three groups based on number of fulfilled metabolic syndrome criteria: group 1 (three metabolic syndrome criteria), group 2 (four metabolic syndrome criteria) and group 3 (five metabolic syndrome criteria). RESULTS: Patients with the metabolic syndrome had a higher increased resting heart rate, QTcd, prolonged QRS and QTc duration. Resting heart rate increases significantly parallel to the increase in the metabolic syndrome score across the groups, whilst QRS duration remained unchanged. QTc duration and QTc dispersion were significantly higher in groups 2 and 3 when compared to group 1. However, no significant differences were observed between groups 2 and 3. CONCLUSION: We demonstrated that the metabolic syndrome and its score related with increased resting heart rate and prolonged repolarization durations in patiens without overt diabetes mellitus. These pro arrhythmogenic parameters could be used in the development of risk stratification schemes for sudden cardiac death in patients with the metabolic syndrome.

[A sudden rise in INR due to combination of Tribulus terrestris, Avena sativa, and Panax ginseng (Clavis Panax)]. / Tribulus terrestris, Avena sativa ve Panax ginseng kombinasyonu (Clavis Panax) kullanimina bagli ani INR yükselmesi.

Warfarin sodium is an antithrombin agent used in patients with prosthetic valve and atrial fibrillation. However, there are many factors that can change the effectiveness of the drug. Today, herbal mixtures promoted through targeted print and visual media can lead to sudden activity changes in patients using warfarin. In this case report we will present two cases with a sudden rise in INR due to using combination of Tribulus terrestris, Avena sativa and Panax ginseng (Panax Clavis). Two patients who used warfarin due to a history of aortic valve replacement (case 1) and atrial fibrillation (case 2) were admitted to the hospital due very high levels of INR detected during routine follow-up. Both patients had used an herbal medicine called ''Panax'' during the last month. The patients gave no indication regarding a change in diet or the use of another agent that might interact with warfarin. In cases where active bleeding could not be determinated, we terminated the use of the drug and re-evaluated dosage of warfarin before finally discharging the patient.

[Primary coronary intervention for acute ST-elevation myocardial infarction in a patient with immune thrombocytopenic purpura]. / Immün trombositopenik purpurali bir hastada akut ST yükselmeli miyokart enfarktüsü için primer koroner girisim uygulamasi

The ideal treatment for acute myocardial infarction in patients with idiopathic thrombocytopenic purpura (ITP) is not well-known. A 42-year-old male patient with a previous diagnosis of chronic and refractory ITP was admitted with chest pain of four-hour onset. Findings of electrocardiography was consistent with acute anteroseptal myocardial infarction. He had no risk factors for coronary heart disease and was not receiving treatment for ITP, and his platelet count varied between 11,000 and 40,000/µl before presentation, without any event of bleeding. Transthoracic echocardiography showed hypokinesia of the anterior, middle, and apical segments. Cardiac enzyme levels were elevated and platelet count was 41,000/µl. Coronary angiography revealed total occlusion of the left anterior descending artery. Primary percutaneous coronary intervention (PCI) was performed, which included predilation and stenting of the lesion. There were no bleeding or ischemic complications during or after PCI and the patient was discharged on the fifth day without any symptoms. He was instructed to take 75 mg clopidogrel daily for two weeks. He was symptom-free at a control visit after this period, with normal left ventricular wall motion on echocardiography.

[The impact of chronic kidney disease on in-hospital clinical outcomes in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction]. / Primer anjiyoplasti uygulanan ST yükselmeli miyokart enfarktüslü hastalarda kronik böbrek hastaliginin hastaneiçi klinik sonuçlar üzerine etkisi.

OBJECTIVES: We investigated the effect of chronic kidney disease (CKD) on in-hospital results in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction (STEMI). STUDY DESIGN: The study included 2,486 patients (2,070 men, 416 women) who were treated with primary angioplasty for STEMI. Of these, 273 patients (11%) were found to have CKD (glomerular filtration rate <60 ml/min/1.73 m2) before the procedure. Patients with and without CKD were evaluated with respect to demographic and clinical features, primary angioplasty findings, and in-hospital clinical results. RESULTS: Patients with CKD exhibited a higher mean age, Killip class, and higher frequencies of female gender, diabetes, hypertension, anemia, and previous myocardial infarction (p<0.05). Angioplasty showed higher rates of right coronary artery lesion, multivessel disease, contrast nephropathy, unsuccessful procedure, and increased stenosis rate and stent length in CKD patients (p<0.05). Cardiovascular mortality occurred in 11.7% and 1.4% of patients with and without CKD, respectively (p<0.001). Patients with CKD had significantly higher incidences of target vessel revascularization, major cardiac events, stroke, cardiopulmonary resuscitation, hemodialysis, ventricular tachycardia/fibrillation, severe heart failure, cardiogenic shock, and significant hemorrhage (p<0.05). Multivariate analysis showed that CKD was an independent predictor of mortality (OR=4.1, 95% CI 1.83-9.17; p=0.001). CONCLUSION: Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality.

[Primary angioplasty in women with ST-elevation myocardial infarction: in-hospital and long-term clinical results]. / ST yükselmeli miyokart enfarktüslü kadinlarda primer anjiyoplasti: Hastaneiçi ve uzun dönem klinik sonuçlar.

OBJECTIVES: We evaluated in-hospital and long-term clinical results of female patients following primary angioplasty for ST-elevation myocardial infarction (STEMI), in comparison with male patients. STUDY DESIGN: We reviewed 2,644 patients (2,188 males, 456 females) who underwent primary angioplasty for STEMI between October 2003 and March 2008. Data on female patients concerning demographic and clinical characteristics, primary angioplasty results, in-hospital and 25-month follow-up results were compared with those of male patients. RESULTS: Hypertension, diabetes mellitus, anemia, shock, and renal failure were more common in female patients, while smoking was more frequent in males (p<0.05). The mean age was higher in female patients (63.9±11.7 vs. 55.2±11.3 years, p<0.001). Females also presented with higher values of glucose, mean platelet volume, and platelet count, and lower hemoglobin and hematocrit values (p<0.05). The frequencies of multivessel disease and procedure failure were significantly higher, and pain-to-balloon time was significantly longer in females (p<0.05). Mortality associated with cardiovascular causes occurred in 148 patients (5.6%), being significantly higher in females (9.4% vs. 4.8%, p<0.001). In-hospital mortality, major cardiac events, stroke, cardiogenic shock, and major bleeding were more frequent in women (p<0.05). Long-term mortality rate was also significantly higher in females (10% vs. 4.5%, p<0.001). Multivariate analysis showed female gender as one of the independent predictors of mortality (odds ratio=1.75, 95% CI 1.02-2.99; p<0.04). CONCLUSION: Female patients with STEMI undergoing primary angioplasty have a higher risk profile and poorer in-hospital and follow-up clinical results. Therefore, female patients should be treated more aggressively.

The outcome of primary percutaneous coronary intervention for stent thrombosis causing ST-elevation myocardial infarction.

BACKGROUND: There are very few scientific data about the effectiveness of primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) due to stent thrombosis (ST). The purpose of the present study is to investigate the efficacy and outcome of primary PCI for STEMI due to ST in the largest consecutive patient population with ST reported to date. METHODS: A total of 2,644 consecutive STEMI patients undergoing primary PCI were retrospectively enrolled into the present study. The primary end point of this study was successful angiographic reperfusion defined as postprocedural Thrombolysis In Myocardial Infarction grade III flow. The secondary end points were cardiovascular death and reinfarction. RESULTS: Stent thrombosis was the cause of STEMI in 118 patients (4.4%). In patients with ST, angiographic success (postprocedural Thrombolysis In Myocardial Infarction grade III flow) was worse than in patients with de novo STEMI (76.3% vs 84.8%, P = .01). Patients with ST had significantly higher incidence of in-hospital cardiovascular mortality than patients with de novo STEMI (10.2% vs 5.3%, P = .02). In-hospital reinfarction rate was similar in both groups. In addition, long-term (mean 22 months) cardiovascular mortality and reinfarction rates were significantly higher in patients with ST compared with those without (17.4% vs 10.5%, P = .02 and 15.6% vs 9.5%, P = .03, respectively). CONCLUSIONS: Primary PCI for treatment of ST is less effective, and these patients are at increased risk for in-hospital and long-term mortality compared with patients undergoing primary PCI due to de novo STEMI.

Anterior mitral valve length is associated with ventricular tachycardia in patients with classical mitral valve prolapse.

BACKGROUND: The aim of this study was to investigate the electrocardiographic and echocardiographic predictors of ventricular tachycardia (VT) in patients with classical mitral valve prolapse (MVP). METHODS: Thirty patients (nine men and 21 women; mean age, 41.5 ± 15 years) in sinus rhythm with mitral valve prolapse who had VT in 24-hour Holter analysis and 30 patients with MVP without VT (eight men and 22 women; mean age, 43 ± 16 years) were included in this study. Transthoracic echocardiography, QT analyses from 12-lead electrocardiography, and 24-hour Holter electrocardiogram recordings were performed. RESULTS: Mitral posterior leaflet thickness (0.48 ± 0.03 cm vs 0.43 ± 0,08 cm, P = 0.025), mitral anterior leaflet length (3.2 ± 0.24 cm vs 2.9 ± 0.36, P < 0.001), mitral posterior leaflet length (2.2 ± 0.3 cm vs 1.9 ± 0.35 cm, P = 0.01), left atrium anteroposterior diameter (4.2 ± 0.8 cm vs 3.5 ± 0.5 cm, P = 0.001), and mitral annulus circumference (15.7 ± 1.3 cm vs 14.6 ± 1.6 cm, P = 0.004) were increased significantly in MVP cases with VT. No significant difference was found between the cases with and without VT in terms of frequency- and time-domain analysis. QT dispersion (72 ± 18 ms vs 55 ± 15 ms, P = 0.0002) and corrected QT dispersion (QTcD) (76 ± 18 ms vs 55 ± 15 ms, P = 0.0002) were significantly increased in cases with VT compared with those without VT. Based on logistic regression analysis for MVP cases, in the case of VT, an enhancement in QTcD (P = 0.01) and the mitral anterior leaflet length (P = 0.003) were the independent predictors of VT. CONCLUSION: Mitral anterior leaflet length and enhanced QTcD are closely related with VT in patients with classical MVP.

Comparison of primary percutaneous coronary intervention and streptokinase for acute isolated inferior ST elevation myocardial infarction with a predicted low risk profile.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is the treatment of choice for acute myocardial infarction, especially for high-risk patients, but the data for low-risk patients are conflicting. A very low-risk subgroup of acute inferior myocardial infarction can be identified by electrocardiographic and clinical criteria during admission. We aimed to compare the outcomes of primary PCI and streptokinase treatment in this subgroup, which has not been evaluated separately before. MATERIAL/METHODS: We retrospectively analyzed in-hospital and 10-month follow-up outcomes of 97 patients with inferior acute myocardial infarction and clinical and electrocardiographic criteria predicting low risk who have been treated with primary PCI or streptokinase. RESULTS: Forty-eight patients received streptokinase, and 49 had undergone primary PCI. Both during the in-hospital period and follow-up, the groups did not differ in the end points of death, reinfarction, or stroke (in-hospital: 2.1% versus 4.1%, P=.57; follow-up: 8.9% versus 8.9%, P=1.000). Length of hospital stay was longer in the streptokinase group (6.5+/-2.5 versus 9.1+/-3.7 days, P=.001). Rate of repeat revascularization was reduced in the PCI group at 10 months (28.9% versus 55.6%, P=.002). CONCLUSIONS: When streptokinase and primary PCI are compared in isolated inferior acute myocardial infarction patients with a low-risk profile, there are no differences for in-hospital and long-term rates of death, reinfarction, or stroke. Primary angioplasty reduces the length of initial hospital stay, and reduces repeat admissions by decreasing the need for subsequent revascularization procedures. Large-scale studies are needed to reach a final conclusion.

Comparison of left ventricular contractility in pressure and volume overload: a strain rate study in the clinical model of aortic stenosis and regurgitation.

OBJECTIVE: The aim of this study is to compare the impact of two different loading conditions on myocardial contractility in asymptomatic patients with normal EF by using stain rate imaging (SRI). METHODS: A total of 27 patients with severe aortic regurgitation (mean age 50 ± 11 years) and 25 patients with severe aortic stenosis (mean age 53 ± 15 years) were prospectively recruited. Fifteen healthy subjects (mean age 50 ± 6 years) were enrolled as the control group. For the evaluation myocardial contractility, longitudinal LV function was chosen and, midventricular segment shortening was analyzed for the septum, LV lateral wall from apical four-chamber view and for the anterior, inferior wall from apical two-chamber view. RESULTS: Longitudinal peak systolic strain rate values of each segment derived from analysis of a total of 804 segments were significantly decreased in the patients population (P < 0.001). Global longitudinal peak systolic strain rate was also significantly decreased in aortic stenosis and regurgitation compared to the control group (-1 ± 0.5, -0.9 ± 0.3, and -1.6 ± 0.3, P = 0.001). As far as the comparison between patients with aortic stenosis and aortic regurgitation, neither global strain rate nor strain rate for each wall was found to be different. CONCLUSION: We conclude that longitudinal LV function is reduced in both pressure and volume overload, and both of this overload patterns are equally harmful to the ventricle.

Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?

OBJECTIVE: The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). METHODS: 2482 consecutive patients with STEMI (mean age 56.5 +/- 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level > or =200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n=1806) patients; diabetic/non-hyperglycaemic (DNH, n=271) patients; non-diabetic/hyperglycaemic (NDH, n=64); and diabetic/hyperglycaemic (DH, n=341). RESULTS: In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac events [MACE]) in the hospital were also higher in NDH (18.8%) compared with other patients (DH, 13.8% vs. DNH, 10.3% vs. NDNH, 3.7%, P < 0.001). The median follow-up time was 21 months.The Kaplan-Meier survival plot for long-term cardiovascular death was worst for DH patients (log rank P < 0.001). After adjustment for potentially confounding factors, NDH (OR 3.04, 95% CI 1.06-8.73; P = 0.03), and DH (OR 2.3,95% CI 1.29-4.09; P = 0.005), but not DNH (OR 1.22,95% CI 0.57-2.6; P = 0.6) status, remained independent predictors of long-term cardiovascular mortality. CONCLUSIONS: STEMI patients with NDH represent the highest risk population for in-hospital mortality, and MACE. The worst outcomes for long-term cardiovascular mortality occur in DH patients.

[Primary percutaneous coronary intervention in patients admitted with cardiogenic shock and ST-elevation myocardial infarction: prognosis and predictors of in-hospital mortality]. / Kardiyojenik sokla basvuran ST yükselmeli miyokart enfarktüslü hastalarda primer perkütan koroner girisim: Prognoz ve hastane içi mortalitenin belirleyicileri.

OBJECTIVES: We investigated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients admitted with cardiogenic shock and ST-elevation myocardial infarction (STEMI). STUDY DESIGN: We reviewed 91 consecutive patients (66 males, 25 females; mean age 61 ± 11 years) treated with primary PCI for cardiogenic shock due to STEMI. All clinical, angiographic data, and in-hospital and long-term outcomes were collected. The patients were classified into two groups depending on the presence (n = 59, 64.8%) or absence (n= 32, 35.2%) of in-hospital mortality. RESULTS: Hospital nonsurvivors were older (mean age 62.7 ± 11.1 vs. 57.7 ± 11.4 years; p = 0.04) and exhibited higher frequencies of diabetes mellitus (DM), renal failure, and history of myocardial infarction. Multi-vessel disease (p = 0.004) and circumflex artery involvement (p = 0.03) were more frequent and the rates of tirofiban administration (p = 0.02) and stenting (p = 0.007) were lower in nonsurvivors. Procedural success rate was substantially lower in nonsurvivors (39% vs. 84.4%; p < 0.001). Of 32 survivors, cardiovascular mortality occurred in only three patients (9.4%) during a median follow-up of 26 months. In multivariate regression analysis, unsuccessful procedure (OR 7.2, 95% CI 1.77-29.27; p = 0.006) and DM (OR 3.92, 95% CI 1.13-13.62; p = 0.03) were the independent predictors of in-hospital mortality. CONCLUSION: Mortality rate is considerably higher and successful procedure yields a two-fold decrease in in-hospital mortality in patients with cardiogenic shock complicated by STEMI. Unsuccessful procedure and DM represent as two independent predictors of in-hospital mortality.

[Gastrointestinal bleeding in patients undergoing primary angioplasty for acute myocardial infarction: incidence, risk factors and prognosis]. / Akut miyokart enfarktüsü nedeniyle primer anjiyoplasti uygulanan hastalarda gastrointestinal kanama sikligi, risk faktörleri ve prognoz.

OBJECTIVES: We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). STUDY DESIGN: We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5+/-11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion. RESULTS: Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9+/-13.5 years vs. 56.4+/-11.8 years; p<0.001), exhibited higher frequencies of female gender (p=0.016), renal failure (p<0.001), and admission anemia (p<0.001), and had a lower procedural success rate (77.9% vs. 91.5%; p=0.02). The development of GIB was associated with significantly higher in-hospital mortality (18.5% vs. 2.9%; p<0.001), longer hospital stay (13.1+/-6.8 days vs. 7.0+/-3.7 days, p=0.02), and increased inotropic requirement (37% vs. 6.7%; p<0.001). In multivariate analysis, inotropic requirement (OR 4.17, 95% CI 1.7-10.4; p=0.002), age above 70 years (OR 3.33, 95% CI 1.4-8.0; p=0.007), and glomerular filtration rate lower than 60 ml/min/1.73 m(2) (OR 2.96, 95% CI 1.2-7.4; p=0.02) were independent predictors of in-hospital GIB. CONCLUSION: The development of GIB is not an uncommon complication after primary PCI for STEMI. These patients have a prolonged hospital stay and increased in-hospital mortality. Increased inotropic requirement, age above 70 years, and impaired renal function are independent predictors of this complication.