Venous leg symptoms, ecchymosis, and coldness in patients with peripheral varicose vein: A multicenter assessment and validation study (VEIN-VIOLET study).

OBJECTIVES: We aimed to evaluate peripheral varicose vein symptoms including ecchymosis and coldness by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire. METHODS: A total of 1120 patients were enrolled to the analysis after the exclusion of 199 patients who did not match the inclusion criteria. Patients were asked to answer the VEINES-Sym questionnaire and questions about ecchymosis and coldness. Scores of ecchymosis and coldness were calculated similar to VEINES-Sym questionnaire. Classifications of peripheral varicose vein were made according to the clinical part of clinical, etiological, anatomical, and pathophysiological classification system and patients with grade 2 or higher were considered as positive for peripheral varicose vein. RESULTS: Frequency of symptoms present in the VEINES-Sym instrument, ecchymosis and coldness were significantly higher in patients with peripheral varicose vein. Mean score of each symptom was significantly lower in peripheral varicose vein patients including scores of ecchymosis and coldness. Logistic regression analysis revealed that presence of hemorrhoids and all symptoms in VEINES-Sym questionnaire except restless leg were significantly and independently associated with peripheral varicose vein. Besides, ecchymosis (odds ratio: 2.04, 95% confidence interval: 1.34-3.08, p = 0.008) but not coldness was significantly and independently associated with peripheral varicose vein. There was also significant correlation of VEINES-Sym score with ecchymosis (r = 0.43, p < 0.001) and coldness (r = 0.47, p < 0.001). CONCLUSIONS: Venous leg symptoms present in VEINES-Sym questionnaire except restless legs, presence of hemorrhoids and ecchymosis are significantly and independently associated with peripheral varicose vein. Not only ecchymosis but also coldness has shown an independent association with total VEINES-Sym score.

Side-wire technique for percutaneous pulmonary balloon valvuloplasty.

On occasion during percutaneous pulmonary balloon valvuloplasty, a small balloon may slip into the pulmonary artery when dilating a stenotic pulmonary valve. In order to stabilize the balloon should a larger balloon size not be available, a side wire can be used without changing the original balloon.

[An effective and safe alternative to epicardial pacemaker placement for permanent pacemaker implantation in a patient with mechanical tricuspid valve: stimulation of the left ventricle through the coronary sinus]. / Mekanik triküspit protez kapagi olan bir hastada kalici kalp pili yerlestirilmesinde epikardiyal yaklasimin güvenli ve etkili seçenegi: Koroner sinüs yoluyla sol ventrikülün uyarilmasi

Implantation of a transvenous endocardial pacemaker is contraindicated in patients with a mechanical tricuspid valve. An epicardial left ventricular pacemaker lead was placed by a transvenous route through the coronary sinus into the lateral cardiac vein in a 58-year-old woman with mechanical aortic, mitral, and tricuspid valves, for permanent pacing due to chronic atrial fibrillation with a slow ventricular rate accompanied by syncope. This lead was then connected to a single-chamber pacemaker. The patient had no problem in the following three months. Placement of an epicardial pacing lead through the coronary sinus provides a safe and effective pacing in patients with a mechanical tricuspid valve, thus obviating major cardiac surgery.

Long-term follow-up data of coronary sinus stenting for the stabilization of the left ventricular leads.

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.

Risk factors for in-hospital mortality in infective endocarditis: five years' experience at a tertiary care hospital in Turkey.

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.

Ascending aortic pressure-derived indices are associated with the presence and severity of aortic stenosis.

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.

Echocardiographic Findings in Patients with Atrial Septal Aneurysm: A Prospective Case-Control Study.

BACKGROUND: Atrial septal aneurysm (ASA) is a congenital deformity of the interatrial septum with a prevalence of 1-2% in the adult population. Although ASA has been supposed to be an incidental finding in echocardiographic examination, its structural and clinical associations have gained an increasing interest. AIM: To investigate and compare the clinical features and echocardiographic parameters between ASA patients and age- and gender-matched control group patients. METHODS: 410 patients with ASA were enrolled in the study, prospectively. After the exclusion of 33 patients, the remaining 377 patients comprised the study group. The control group consisted of 377 age- and gender-matched patients without ASA. RESULTS: Aortic valve regurgitation and mitral valve regurgitation were more often observed in patients with ASA, and percentages of patients with ascending aortic aneurysm (AAA), patent foramen ovale (PFO), and atrial septal defect (ASD) were higher in ASA patients compared to control group patients. Aortic root diameter was larger in ASA patients compared to control group patients (29.2 ± 3.9, 28.6 ± 3.1, p=0.05, respectively). Ascending aorta diameter was higher in ASA patients compared to patients without ASA (44 ± 0.3, 41.5 ± 0.2, p=0.02). Logistic regression analysis revealed that mitral valve regurgitation (OR: 2.05, 95% CI : 1.44-2.92, p < 0.001) and PFO (OR: 11.62, 95% CI : 2.64-51.02, p=0.001) were positively and independently associated with the presence of ASA. AAA tended to be statistically and independently associated with ASA (OR: 2.69, 95% CI : 0.97-7.47, p=0.05). CONCLUSIONS: We have demonstrated a higher incidence of mitral/aortic valvular regurgitations, AAA, PFO, and ASD in ASA patients compared to age- and gender-matched control group patients. In addition, we have shown that ASA is significantly and positively associated with mild mitral regurgitation and PFO.

Effect of aortic pulse and fractional pulse pressures on early patency of sapheneous vein grafts.

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.

Serum gamma-glutamyl transferase activity increased in patients with coronary artery ectasia.

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.

Imaging of coronary artery anomalies: the role of multidetector computed tomography.

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.

Imaging of coronary artery fistulas by multidetector computed tomography: is multidetector computed tomography sensitive?

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.

Relation of admission QRS duration with development of angiographic no-reflow in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous interventions.

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.

Relationship of admission haematological indices with infarct-related artery patency in patients with acute ST-segment elevation myocardial infarction treated with primary angioplasty.

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.

Acute pericarditis as a complication of percutaneous mitral balloon valvulotomy.

During the past two decades, percutaneous mitral balloon valvulotomy (PMBV) has been frequently used, with high success and low complication rates, in the treatment of patients with moderate to severe rheumatic mitral stenosis. The case is reported of a patient with severe rheumatic mitral stenosis who developed acute pericarditis two days after successful PMBV. To the best of the authors' knowledge, this is the first such case to be reported.

A pericardial hydatid cyst masquerading as acute inferolateral myocardial infarction--a case report.

A case of pericardial hydatid cyst adjacent to the inferoposterial wall of the left ventricle is reported. Significant ST segment elevations in leads D2, D3, aVF, V5, and V6 on surface electrocardiography and sudden onset of severe chest pain mimicked acute inferolateral myocardial infarction. However, cardiac catheterization and coronary angiography showed normal coronary arteries and normal left ventricular cavity. The ST segment elevation in the inferolateral leads disappeared a few days after surgical resection of the cyst. Cardiac hydatid cyst should be considered in the differential diagnosis of patients with angina-like chest pain in endemic areas.

Increased levels of soluble adhesion molecules E-selectin and P-selectin in patients with cardiac syndrome X.

The role of endothelial dysfunction and platelet activation in patients with cardiac syndrome X is controversial. The aim of this study was to investigate the plasma levels of circulating E- and P-selectin molecules in patients with syndrome X. The study included 21 patients with cardiac syndrome X (11 men and 10 women, mean age = 56 +/- 5 years) and 20 patients with significant coronary artery disease who had stable angina pectoris (11 men and 9 women, mean age = 60 +/- 8 years). Twenty-two age- and sex-matched subjects (12 men and 10 women, mean age = 58 +/- 8 years) undergoing diagnosis of atypical chest pain in whom coronary arteries were found normal and exercise test had no signs of ischemia served as the control group. Syndrome X was defined as presence of typical chest pain on exertion or at rest with positive exercise test and angiographically normal epicardial coronary arteries with no evidence of coronary spasm after intracoronary infusion of ergonovine maleate. The mean plasma concentrations of P-selectin were significantly elevated both in patients with coronary artery disease and syndrome X as compared with control subjects (49.15 +/-7.47 and 42.80 +/- 8.93 vs 22.63 +/-6.47 ng/mL, p < 0.001). Similarly, both patients with coronary artery disease and syndrome X had higher plasma concentrations of E-selectin than the control group (78.85 +/- 16.69 and 68.38 +/- 15.30 vs 36.43 +/- 4.72 ng/mL, p < 0.001). In conclusion, patients with syndrome X had increased plasma concentrations of soluble adhesion molecules, E-selectin and P-selectin, reflecting an ongoing chronic inflammation involved with endothelial dysfunction and enhanced platelet activation/damage in this setting.

Effect of infective endocarditis on blood coagulation and platelet activation and comparison of patients with to those without embolic events.

Inflammation-induced procoagulant changes and alterations in platelet activity appear to play an important role in thromboembolic complications of infective endocarditis (IE). The aim of this study was to investigate systemic coagulation activity, fibrinolytic capacity, and platelet activation in IE patients with and without embolic events by measuring the plasma levels of prothrombin fragment 1 + 2, thrombin-antithrombin III complex, plasminogen activator inhibitor-1, beta-thromboglobulin, and platelet factor 4. The study included 76 consecutive patients with definite IE according to the Duke criteria. Among them, 13 (17.1%) had major embolic events. Plasma concentrations of prothrombin fragment 1 + 2 (3.2 +/- 1.3 vs 1.7 +/- 0.7 and 1.4 +/- 0.7 nmol/L, p <0.001, respectively) and thrombin-antithrombin (7.3 +/- 1.5 vs 2.9 +/- 1.2 and 2.2 +/- 1.1 ng/ml, p <0.001, respectively) were elevated in patients with embolic events compared with both patients without embolic events and control subjects. Similarly, patients with embolic events had increased plasma levels of beta-thromboglobulin (63.3 +/- 10.9 vs 33.1 +/- 11.6 and 19.1 +/- 10.6 ng/ml, p <0.001, respectively) and platelet factor 4 (106.0 +/- 28.7 vs 50.3 +/- 16.7 and 43.0 +/- 15.8 ng/ml, p <0.001, respectively) compared with those without embolic events and the control group. Embolic patients also had higher plasminogen activator inhibitor-1 levels than both nonembolic patients and healthy subjects (14.4 +/- 6.4 vs 8.6 +/- 5.9 and 5.4 +/- 4.3 ng/ml, p = 0.002, respectively). In conclusion, IE patients with subsequent thromboembolism have increased systemic coagulation activation, enhanced platelet activity/damage, and impaired fibrinolysis. The resulting imbalance produces a sustained hypercoagulable state that may contribute to the increased risk of thromboembolic events in this particular group.

Changes in plasma levels of adhesion molecules after percutaneous mitral balloon valvuloplasty.

BACKGROUND: Adhesion molecules are expressed on vascular endothelium and on immune and inflammatory cells. Recently increased levels of adhesion molecules have been shown in patients with rheumatic mitral stenosis. This study examined the serum levels of the adhesion molecules intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin in patients with rheumatic mitral stenosis and the effects of percutaneous mitral balloon valvuloplasty (PMBV) on these adhesion molecules. MATERIALS AND METHODS: Thirty five patients (3 men, 32 women, mean age 39+/-5 years) with severe rheumatic mitral stenosis who underwent percutaneous balloon mitral valvuloplasty, and 35 age and sex matched healthy control subjects were included in the study. Serum levels of ICAM-1, VCAM-1, and E-selectin were measured in all patients who underwent PMBV and in all control subjects. Blood samples were taken for measurement of adhesion molecules immediately before and 24 h after the mitral balloon valvuloplasty. RESULTS: The plasma levels of soluble adhesion molecules E-selectin, ICAM-1 and VCAM-1 were significantly elevated in patients with mitral stenosis compared to control subjects: E-selectin, 97+/-59 vs. 45+/-24 ng/ml (P=.001), sICAM-1, 874+/-301 ng/ml vs. 238+/-82 ng/ml (P<.0001); sVCAM-1, 3056+/-763 ng/ml vs. 985+/-298 ng/ml (P<.0001). Plasma levels of VCAM-1 significantly increased 24 h after the valvuloplasty procedure (3056+/-763 ng/ml vs. 3570+/-1225 ng/ml P=.013). Plasma levels of E-selectin showed a significant decrease after PMBV (97+/-59 vs. 70+/-58 ng/ml, P=.043) and plasma levels of ICAM-1 did not show any change after PMBV (874+/-301 vs. 944+/-377 ng/ml, P=.356). CONCLUSION: Cellular adhesion molecules, sICAM-1, E-selectin, sVCAM-1 have shown changes in different directions in response to PMBV. These results necessitate further studies to clarify the mechanism underlying the association between adhesion molecules and PMBV as well as rheumatic mitral stenosis.

Comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion for detection of myocardial viability after anterior myocardial infarction.

BACKGROUND: Low-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) infusion has been shown to increase contraction of the ischemic zone. The aim of this study was to compare LDDSE and echocardiography during GIK infusion for detection of myocardial viability. METHODS: Thirty-two patients who had first anterior myocardial infarction (MI) without previous MI were included in the study. Echocardiographic evaluation was carried out on the 7th +/- 2 days after MI. During continuous electrocardiographic, blood pressure and echocardiographic monitoring, an intravenous infusion of dobutamine (3 microg/kg body weight/min) was started with an infusion pump, continued for 5 min and then increased to 5 microg/kg/min and 10 microg/kg/min for another 5 min. The GIK protocol consisted of a fixed dose of insulin (100 microU/kg/h intravenously) and a variable glucose/potassium infusion rate. GIK echocardiography was done at baseline and after 60 min of GIK. The detected viable myocardium was defined as one or two scores decreasing in at least two adjacent abnormal segments during LDDSE and GIK echocardiography. RESULTS: Under resting conditions 225 segments (44%) were normokinetic, 21 segments (4%) dyskinetic, 117 segments (23%) akinetic and 149 segments (29%) hypokinetic. Viability was detected in 20% (57 segments) of the asynergic segments at baseline with GIK echocardiography and in 22% (62 segments) of those segments with LDDSE (P < 0.05). Left ventricular wall motion score index at baseline was 1.87 and it decreased significantly indicating improvement in left ventricular systolic function during both LDDSE and GIK echocardiography (P < 0.001, versus 1.75 and 1.76 respectively). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 96%. CONCLUSION: We have shown that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocardiography could be used to detect myocardial viability after acute MI.