Comparison of single-dose and repeated levosimendan infusion in patients with acute exacerbation of advanced heart failure.

BACKGROUND: Levosimendan (LS) is a novel inodilator that improves cardiac performance, central hemodynamics, and symptoms of patients with decompensated chronic heart failure. The aim of this study was to compare the effects of single and repeated LS infusion on left ventricular performance, biomarkers, and neurohormonal activation in patients with acute heart failure. MATERIAL AND METHODS: Twenty-nine consecutive patients with acute exacerbation of advanced heart failure were included in this study. LS was initiated as a bolus of 6 µg/kg followed by a continuous infusion of 0.1 µg/kg/min for 24 hours in both groups who received intravenous single and repeated (baseline and at 1 and 3 months) treatment. Physical examination, echocardiography, and biochemical tests (brain natriuretic peptide, tumour necrosis factor-alpha, interleukin-1beta, 2, and 6) were performed before treatment and on 3 day of the treatment. The last evaluation was performed at 6 month after the baseline treatment. RESULTS: Twenty male and 9 female patients with mean age of 60.2 ± 7.4 years were included in this study. A significant improvement in New York Heart Association functional status and myocardial performance index was detected only in the repeated LS treated patients at 6 month compared to the pretreatment status (p=0.03 and p<0.001; respectively). In addition, a significant decrease in brain natriuretic peptide (p<0.01) and plasma interleukin-6 (p=0.05) levels were also achieved only in patients who were given repeated LS. CONCLUSIONS: Our study showed that repeated LS treatment is more effective compared to the single dose LS treatment in improving clinical status, hemodynamic and laboratory parameters in patients with acute exacerbation of advanced heart failure.

Evaluation of arterial stiffness for predicting future cardiovascular events in patients with ST segment elevation and non-ST segment elevation myocardial infarction.

BACKGROUND: Arterial stiffness parameters in patients who experienced MACE after acute MI have not been studied sufficiently. We investigated arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). METHODS: Ninety-four patients with acute MI (45 STEMI and 49 NSTEMI) were included in the study. Arterial stiffness was assessed noninvasively by using TensioMed Arteriograph. RESULTS: Arterial stiffness parameters were found to be higher in NSTEMI group but did not achieve statistical significance apart from pulse pressure (P = 0.007). There was no significant difference at MACE rates between two groups. Pulse pressure and heart rate were also significantly higher in MACE observed group. Aortic pulse wave velocity (PWV), aortic augmentation index (AI), systolic area index (SAI), heart rate, and pulse pressure were higher; ejection fraction, the return time (RT), diastolic reflex area (DRA), and diastolic area index (DAI) were significantly lower in patients with major cardiovascular events. However, PWV, heart rate, and ejection fraction were independent indicators at development of MACE. CONCLUSIONS: Parameters of arterial stiffness and MACE rates were similar in patients with STEMI and NSTEMI in one year followup. The independent prognostic indicator aortic PWV may be an easy and reliable method for determining the risk of future events in patients hospitalized with acute MI.

The Turkish registry of heart valve disease.

OBJECTIVES: Valvular heart diseases (VHD) occur frequently in Turkey. However, epidemiological studies of VHD have not been completed until now. The aim of this study is to identify the VHD type, clinical, laboratory characteristics, and treatment methods among VHD patients in Turkey. STUDY DESIGN: The study was conducted prospectively between June 2009 and June 2011 at 42 centers, and included patients with native VHDs, infective endocarditis, and/or previous valve interventions. RESULTS: All medical data from 1300 patients were recorded. Mean age was 57±18 years and the female/male ratio was 1.5. VHD was native in 84% of patients, 15% had previous interventions, and 1% had infective endocarditis. Among the native VHDs, mitral regurgitation was the most frequent lesion (43%), followed by multiple VHDs (32%). Degenerative etiology (86%) was more frequent in aortic VHD, and rheumatic origin was the main cause in all VHDs. While the prevalence of aortic stenosis increased with age, mitral stenosis decreased with patient age. The most frequent symptom was shortness of breath (73%). Clinical and echocardiographic examinations (54%) were mostly used as diagnostic techniques for determining treatment course. Percutaneous mitral balloon valvuloplasty (PMBV) was performed in 76% of the patients with mitral stenosis and mechanical prosthetic valve replacement was performed in 74% of the patients with other lesions. CONCLUSION: This study showed that the main cause of VHD is rheumatic fever. Mitral regurgitation and multiple valvular lesions are the most frequent VHDs in Turkey. PMBV and mechanical prosthetic valve replacement are the preferred treatment methods for VHD.

Anti-inflammatory treatment improves systolic and diastolic tissue doppler parameters in patients with newly diagnosed rheumatoid arthritis.

BACKGROUND: The frequency of cardiovascular system involvement is increased in rheumatoid arthritis (RA) and may result in serious morbidity and mortality. Early intervention and control of the disease activity may reduce the risk of cardiovascular events. The purpose of this study is to examine the effects of steroids and methotrexate (Mtx) on the heart functions of newly diagnosed RA patients. METHODS: Our study is a prospective cohort study involving thirty-six newly diagnosed RA patients according to the American Society of Rheumatology classification criteria. Right and left ventricular echocardiography, and Doppler parameters were evaluated in these patients thrice; before treatment, after one month of steroid treatment, and after three months of Mtx treatment, and laboratory/clinical parameters were noted. RESULTS: The mean age of the patients was 52.66 ± 13.66 years. After the treatment, a significant decrease was observed in the values of inflammatory markers (ESR and CRP) and disease activity score (DAS28) [p < .05]. Left ventricular tissue Doppler showed an increase in lateral S, septal S, and mitral S waves compared to baseline (8.37 ± 1.89 vs 10.0 ± 1.8 cm/s p = .001). While there was a decrease in tissue Doppler tricuspid a wave (18.33 ± 4.76 vs 15.63 ± 4.36 p = .016), an increase in Tricuspid E/e' value and Tricuspid tissue Doppler e/a value was detected after treatment (0.76 ± 0.30) vs 0.94 ± 0.53) p < .010). Significant changes were found to be more prominent after the Mtx treatment. CONCLUSION: In RA patients, steroid and Mtx treatment significantly positively affects left ventricular systolic and right ventricular diastolic functions.

[Anomalous single coronary artery presenting as typical angina pectoris: a case report]. / Tipik angina pektorise neden olan tek koroner arter anomalisi: Olgu sunumu.

Single coronary artery is described as an isolated coronary artery originating from the aortic root through a single ostium in the absence of another ostium, where isolated coronary artery is the only source for blood supply to the whole heart. We present a 53-year-old woman whose coronary angiography for typical chest pain revealed an isolated single coronary artery. On coronary angiography, the whole coronary system originated by a single trunk from the right sinus of Valsalva. Multislice computed tomography showed that the left anterior descending, circumflex, and right coronary arteries arose from a single ostium in the right sinus of Valsalva without a left main trunk. Despite maximal medical therapy, her chest pain persisted. The patient did not accept surgical treatment proposed for correction of the anomaly.

Usefulness of N-terminal pro-B-type natriuretic peptide increase with exercise for predicting cardiovascular mortality in patients with heart failure.

N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) level at rest is related to left ventricular (LV) function and cardiovascular mortality in patients with heart failure (HF). There are limited and controversial data regarding changes in NT-pro-BNP level during exercise in patients with HF. The aim of this study was to investigate the effects of exercise on NT-pro-BNP levels and the relation between increases in NT-pro-BNP and the LV ejection fraction and cardiovascular mortality in patients with HF. Seventy-five patients with HF (New York Heart Association classes I to III) and 20 healthy subjects were enrolled in the study. Echocardiographic examination was performed. The modified Bruce protocol was used for symptom-limited exercise testing. Levels of NT-pro-BNP were measured at rest and after peak exercise. The patients were followed up for 690 to 840 days for cardiovascular mortality. Exercise induced significant increases in NT-pro-BNP in patients and controls. Except for a relative increase in NT-pro-BNP during exercise (relative DeltaNT-pro-BNP), NT-pro-BNP concentrations at rest and during peak exercise and absolute increases in NT-pro-BNP during exercise (absolute DeltaNT-pro-BNP) were significantly higher in patients with HF (p <0.001). Absolute DeltaNT-pro-BNP was positively correlated with NT-pro-BNP at rest (p <0.001). The level of absolute DeltaNT-pro-BNP was the most important parameter in predicting a LV ejection fraction <30% (p <0.001). Absolute DeltaNT-pro-BNP and LV end-systolic volume were found to be independent predictors of mortality (p = 0.012 and p = 0.015, respectively). In conclusion, exercise induced increases in NT-pro-BNP in patients and healthy subjects. Absolute increase in NT-pro-BNP is a reliable parameter in predicting a low LV ejection fraction and may help in the identification of patients at high risk for mortality.

The relation between serum erythropoietin level and severity of disease and mortality in patients with chronic heart failure.

OBJECTIVE: We evaluated the relation between serum erithropoietin level and the severity of disease and mortality in patients with chronic heart failure (CHF). METHODS: We enrolled 96 CHF patients and 50 age- and sex-matched control subjects. Haemoglobin, haemotocrit, N terminal pro-B type natriuretic peptide (NT-proBNP) and erythropoietin levels and echocardiographic parameters were measured. The patients were contacted 1 year after the evaluations to determine survival. RESULTS: The patients had lower haemoglobin and haematocrit but higher serum erythropoietin and NT-proBNP levels than the control subjects. Serum erythropoietin and NT-proBNP levels increased with worsening functional class. The serum erythropoietin level correlated negatively with left ventricular ejection fraction (r = -0.404, P < 0.001), haemoglobin (r = -0.530, P < 0.001) and haematocrit (r = -0.496, P < 0.001) levels. The patients who died (n = 17) had lower haemoglobin and haematocrit levels and significantly higher erythropoietin and NT-proBNP levels. However, multivariate logistic regression analysis showed that only NT-proBNP level was an independent predictor of mortality (P = 0.002). CONCLUSION: Anaemia and resistance to erythropoietin develop proportionately to disease severity and left ventricular systolic dysfunction in patients with CHF. Although serum erythropoietin level seems related with mortality, this observation needs to be confirmed by studies with more patients and longer follow-up.

Left atrial size may predict exercise capacity and cardiovascular events in patients with heart failure.

Our aim was to investigate, in patients with heart failure, the relationship between left atrial size and exercise capacity and cardiovascular events. Seventy-five patients (67 men and 8 women; mean age, 53.4 +/- 8.8 yr) with left ventricular ejection fractions of < or =0.45 (New York Heart Association functional classes I-III) were matched by age and sex with 20 healthy control subjects. Echocardiographic examinations were performed, as was exercise testing by the modified Bruce protocol. Patients were monitored for a period of 330 to 480 days for cardiac death or for heart failure that required hospitalization. The indexed left atrial diastolic size (beta level = -0.534, P <0.001) and left ventricular late diastolic filling velocity (beta level = 0.247, P <0.017) were the most important values in predicting low exercise capacity. The only independent predictor of low exercise capacity (<5 METS) was the indexed left atrial diastolic size (odds ratio, 1.428; 95% confidence interval, 1.09-1.702; P <0.001). Every 1 mm/m2 increase in indexed left atrial diastolic dimension caused a 42.8% increase in the risk of severe heart failure (exercise capacity, <5 METS). Independent predictors for cardiovascular events were indexed as left atrial systolic size (odds ratio, 1.383; 95% confidence interval, 1.145-1.671; P <0.001) and left ventricular early diastolic/late diastolic filling velocity (odds ratio, 1.096; 95% confidence interval, 1.010-1.189; P <0.027). Indexed left atrial diastolic and left atrial systolic size predict exercise capacity and cardiovascular events, respectively, in New York Heart Association functional class I through III heart failure patients.

[A case of type IV dual left anterior descending coronary artery anomaly]. / Tip IV çift sol ön inen koroner arter anomalisi: Olgu sunumu.

Dual left anterior descending (LAD) artery is a very rare congenital coronary artery anomaly. A 51-year-old woman presented with atypical chest pain and palpitation. Electrocardiography showed nonspecific ST-segment depression in inferior and lateral leads. Coronary angiography showed a rudimentary LAD artery terminating in the midportion of the anterior interventricular sulcus, after giving the first septal branch. In right coronary angiography, there was another LAD artery originating from the proximal right coronary artery and coursing to the anterior interventricular sulcus. This anomaly was consistent with type IV dual LAD.

Right and left ventricular adaptation to training determined by conventional echocardiography and tissue Doppler imaging in young endurance athletes.

OBJECTIVE: Some findings of left ventricular (LV) functions in athletes are controversial. On the other hand, studies concerning the right ventricle (RV) are limited. The aim of the study was to assess the effects of endurance training on LV and RV systolic and diastolic function. METHODS: A total of 60 (54 male, 6 female) athletes (mean age 20.7 +/- 2.5 years) and 60 (51 male, 9 female) healthy subjects (mean age 21.3 +/- 2.6 years) were included in the study. Standard echocardiographic examination and pulsed wave Doppler and tissue Doppler imaging (TDI) were performed. RESULTS: Except LV and RV ejection fraction, all M-mode echocardiographic parameters of the athletes were found to be significantly greater compared to untrained subjects. LV cavity dimension enlarged (> 55 mm) in 23 (38.4%) athletes but none of the controls. Of 54 male and 6 female athletes 33 (61.1%) and 5 (83.3%) had left vantricular hypertrophy. Athletes also had a greater RV free-wall thickness and mass index. None of the control subjects had either LV or RV hypertrophy. The mean LVMI/RVMI ratio was 3.77 +/- 1.59 and 3.40 +/- 1.32 in athletes and controls, respectively (p = 0.5). The mean E/A and Em/Am ratios and Sm velocities of both ventricles were significantly higher in athletes compared to untrained subjects (p < 0.001). CONCLUSION: Our study shows that despite an increase in left and right ventricular mass indexes, the LVMI/RVMI ratio stays stable. Training results in a better systolic and diastolic function.

The relation between aortic atherosclerosis and risk factors.

OBJECTIVE: To evaluate the impact of risk factors on atherosclerotic changes of aortic wall and valve in patients with and without non-familial hypercholesterolemia by transthoracic echocardiography. METHODS: One hundred and eleven patients with non-familial hypercholesterolemia and 112 control subjects were included in the study. Aortic wall and valve were evaluated by visual assessment of wall hyperechogenicity and measuring the valve thickness. Aortic diameters were obtained at the levels of annulus, sinus of Valsalva and at the supravalvular level in the parasternal long-axis view by M-Mode echocardiographic examination. The relationship between parameters of aortic atherosclerosis and risk factors was studied by multivariate logistic regression analysis, Pearson and Spearman correlation analyses. RESULTS: The prevalence of aortic wall hyperechogenicity was found to be higher in patients with hypercholesterolemia (84.7% vs 70.5%, p=0.01). The mean aortic root diameters at all levels of patients with hypercholesterolemia were found to be significantly smaller than in patients of the control group (3.1+/-0.3 mm vs 3.2+/-0.5 mm, p=0.02 for annulus level, 3.4+/-0.4 mm vs 3.5+/-0.4, p=0.004 mm for the level of sinus of Valsalva and 3.2+/-0.3 mm vs 3.4+/-0.5 mm, p<0.001 - supravalvular level), but no difference was noted regarding the aortic velocity and pressure gradient across the aortic valve. Multivariate stepwise logistic regression analysis showed that age (OR=1.1, CI - 1.02-1.09, p=0.002) and smoking (OR=2.2, CI - 1.06-4.58, p=0.04) were independent predictors of aortic valve thickness. Hypercholesterolemia was an independent predictor for aortic wall hyperechogenicity (OR=2.5, CI - 1.3-4.9, p=0.009) but not for valve thickness. CONCLUSIONS: Age, smoking and hypercholesterolemia are related to atherosclerotic involvement of aortic wall and valve.

Echocardiographic findings in patients with Behçet's disease.

Case-controlled studies have shown that the prevalence of left ventricular (LV) diastolic dysfunction is higher in patients with Behçet's disease. However, there are no data evaluating the value of Doppler tissue imaging (DTI) in Behçet's disease. The aim of this study was to evaluate the cardiac involvement and the LV function at rest and at the end of isometric exercise by pulse-wave Doppler and DTI methods in patients with Behçet's disease. Fifty-four patients with Behcet's disease and 50 control subjects were studied. Dimensions of cardiac chambers, aortic root dimension, valvular abnormalities, and systolic function were similar in both groups. The mean E/A ratio was significantly lower in patients than controls (1.22 +/- .09 vs 1.36 +/- 0.30, p = 0.01). The E/A ratio was <1 in 12 patients (22%) and in 3 controls (6%) (p = 0.02). By DTI, no difference was found in the mean S-, e-, and a-wave velocities, and e/a ratio between the 2 groups. The e/a ratio was <1 in 13 patients (24.1%) and in 7 controls (14%) (p = 0.2) by DTI. There were no differences in the mitral pulse-wave Doppler and DTI parameters in patient and control groups at the end of exercise. The prevalence of cardiac pathology in Behçet's disease did not differ appreciably from the controls. In conclusion, the LV systolic and diastolic functions in the patients with Behçet's disease and controls were similar not only at rest but also at the end of exercise.

Insertion/deletion polymorphism of the angiotensin converting enzyme gene in coronary artery disease in southern Turkey.

Genetic factors are important in the pathogenesis of coronary artery disease (CAD). Angiotensin converting enzyme (ACE) gene insertion(I)/deletion(D) polymorphism is one of the genetic factor found to be related with CAD. We investigated the association between I/D polymorphism of the ACE gene and the presence of CAD. Three hundred and seven patients (187 males and 120 females, aged between 35-80, mean 54.3 +/-9.8 years) who underwent diagnostic coronary angiography were included in the study. ACE I/D polymorphism was detected by polymerase chain reaction. Of the 307, 176 had CAD. The most frequently observed genotype in all subjects was ID (47.9 %). However, in patients with CAD the frequency of II genotype was lower whereas DD genotype was higher compared to the controls (p < 0.05). The number of D allele carrying subjects were also higher (p < 0.05) in CAD patients. The logistic regression analysis indicated that the ACE D allele is an independent risk factor (odds ratio = 1.48, 95 % CI = 1.01-2.18, p < 0.05). In conclusion, the I/D polymorphism of ACE gene (carrying D allele) is an independent risk factor for CAD in the studied Turkish population.

Apical hypertrophic cardiomyopathy: diagnosis with contrast-enhanced echocardiography--a case report.

Apical hypertrophic cardiomyopathy is a rare form of hypertrophic cardiomyopathy (HCM) recognized by a unique spadelike configuration on the left ventriculogram. Two-dimensional echocardiography is another useful tool in the diagnosis of this condition. The diagnosis may be difficult and may mimic akinesia or apical thrombus in some patients with poor acoustic windows. A 50-year-old woman with typical angina and left ventricular hypertrophy with T wave inversion in leads V3-V6, II, III and aVF is presented. Apical HCM was diagnosed with contrast-enhanced echocardiography and confirmed by finding a spadelike configuration on the left ventriculogram. Apical HCM should be considered in patients in whom symptoms and ECG findings mimic ischemic heart disease. Contrast-enhanced echocardiography is a reliable and simple method in the diagnosis of apical HCM.

Mitral annular calcification and aortic valve calcification may help in predicting significant coronary artery disease.

Mitral annular calcification (MAC) and aortic valve calcification (AVC) are manifestations of atherosclerosis. To determine whether mitral annular calcification and aortic valve calcification detected by transthoracic echocardiography (TTE) might help in predicting significant coronary artery disease (CAD), 123 patients with significant CAD and 93 patients without CAD detected by coronary angiography were investigated. MAC and AVC identified CAD with a sensitivity and specificity of 60.2%, 55.9% and 74.8%, 52.7%, respectively, and with a negative and a positive predictive values of 51.5%, 64.3% and 61.3% and 67.6%, respectively. The positive predictive value of MAC was greater than gender, hypertension, and hypercholesterolemia. AVC showed a positive predictive value greater than gender, hypertension, family history, and hypercholesterolemia. The negative predictive values of MAC and AVC for CAD were greater than those of all risk factors except diabetes mellitus. In conclusion, presence of MAC and AVC on TTE may help in predicting CAD and should be added to conventional risk factors. Absence of MVC and AVC is a stronger predictor for absence of CAD than all conventional risk factors, except diabetes mellitus. Patients with MAC and AVC should be taken into consideration for the presence of significant CAD and thereby for diagnostic and therapeutic interventions in order to improve the prognosis.

Effect of the radiographic contrast material iopamidol on hemostasis: an observational study in thirty cardiac patients.

BACKGROUND: In vitro studies have shown that nonionic radiographic contrast material may induce the generation of thrombin in blood, whereas ionic contrast agents, such as iohexol, do not. However, knowledge of the effects of contrast material on coagulation and fibrinolytic systems in vivo is limited. OBJECTIVE: This study was designed to assess the effects of the nonionic radiographic contrast material iopamidol on hemostasis in patients undergoing coronary angiography or cardiac catheterization. METHODS: Patients aged ≥18 years with chest pain and/or dyspnea who underwent coronary angiography or cardiac catheterization with intra-arterial contrast material were assessed for hemostasis. Blood samples were drawn before and 3 minutes after injection of iopamidol. Complete blood count and coagulation profile (bleeding time, clotting time, clot retraction time, euglobulin lysis time [ELT], prothrombin and partial thromboplastin times, coagulation factor I [CFI] level, and platelet factor 3 [PF-3] availability) were assessed. The natural coagulation inhibitors protein C, protein S, and antithrombin III (AT-III) also were measured. RESULTS: Thirty patients (7 males, 23 females; mean [SD] age, 51.3 [20.2] years; range, 17-79 years) were included in this single-center study. All hematologic variables (hemoglobin, white blood cell count, and platelet count) decreased significantly (P<0.001, P<0.001, and P<0.05, respectively) after administration of iopamidol but remained within normal limits. Mean levels of protein C, protein S, and AT-III did not change significantly after administration of iopamidol. Bleeding time was not changed significantly, and PF-3 availability was prolonged in both groups, but the changes were not statistically significant. CONCLUSIONS: In this study population, although hemostasis remained grossly intact after injection of nonionic contrast material, the coagulation system may have been affected by the accelerated consumption of CFI and platelets. The affected variables were platelets, clot retraction time, ELT, and natural coagulation inhibitors (protein C, protein S, and AT-III). Although the natural coagulation inhibitors remained within the normal range, the correlations were found significant. These changes in hemostasis affected the vascular phase. If the vascular compartment, especially the endothelium, remained intact, the infusion of nonionic agents in low concentrations might be safe for angiography and other procedures; however, more studies are needed.

Intimal intussusception in aortic dissection and coexisting coronary artery disease.

Intimal tear is rarely circumferential in aortic dissection. In such an instance, intimal intussusception may occur. This exposes the patient to the additional risk of severe aortic regurgitation, blockage of the left main coronary artery ostium, or both in proximal intimal intussusception in ascending aortic dissection. Here we present a 61-year-old patient with ascending aortic dissection, aortic regurgitation caused by an intussuscepted proximal intimal flap, and coexisting coronary artery disease. The presenting symptoms and electrocardiographic findings simulated an acute coronary syndrome. Among other diagnostic measures, only transesophageal echocardiography clearly defined the pathologic condition. The patient underwent a successful aortic root replacement and coronary artery bypass grafting.

A new index (CHOLINDEX) in detecting coronary artery disease risk.

OBJECTIVE: Coronary artery disease (CAD) risk increases with the elevation of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and low level high-density lipoprotein cholesterol (HDL-C) levels. However, the magnitude at which CAD risk increases with every lipid parameter is controversial. We developed a new index called CHOLINDEX, in order to evaluate CAD risk, and investigated its reliability. METHODS: Three hundred and seven patients (190 males and 117 females, aged between 26-80 years, mean 53.6 ± 10.2 years) who underwent diagnostic coronary angiography were included in the study. Risk factors and lipid profiles of all patients were noted. CHOLINDEX was calculated by using a formula as follows: CHOLINDEX=LDL-C-HDL-C (TG<400 mg/dL), LDL-C-HDL-C + 1/5 of TG (TG ≥ 400 mg/dL). RESULTS: Of the 307 patients, 180 had CAD. We found that age, male gender, hypertension, diabetes mellitus, smoking and CHOLINDEX were independent predictors of CAD. The logistic regression analysis showed that the CHOLINDEX had a much more significant relation with CAD (odds ratio=1.011, 95% CI=1.003-1.019) compared with other lipid parameters. CONCLUSION: CHOLINDEX is a simple index which can be used reliably in prediction of CAD like other lipid parameters in daily clinical practice.

Coronary artery fistula presenting as unstable angina pectoris in patients with antiphospholipid syndrome.

The cardiovascular system is one of the primary targets in patients with antiphospholipid syndrome. The valves are the most frequently affected. Atherosclerosis and coronary thrombosis are also seen. The risk of acute coronary syndrome is 10 times higher in patients with APS. We present an APS patient case who was hospitalized with acute coronary syndrome and who was later found to have coronary artery fistula.

Prediction of pharmacologically induced baroreflex sensitivity from local time and frequency domain indices of R-R interval and systolic blood pressure signals obtained during deep breathing.

Pharmacological measurement of baroreflex sensitivity (BRS) is widely accepted and used in clinical practice. Following the introduction of pharmacologically induced BRS (p-BRS), alternative assessment methods eliminating the use of drugs were in the center of interest of the cardiovascular research community. In this study we investigated whether p-BRS using phenylephrine injection can be predicted from non-pharmacological time and frequency domain indices computed from electrocardiogram (ECG) and blood pressure (BP) data acquired during deep breathing. In this scheme, ECG and BP data were recorded from 16 subjects in a two-phase experiment. In the first phase the subjects performed irregular deep breaths and in the second phase the subjects received phenylephrine injection. From the first phase of the experiment, a large pool of predictors describing the local characteristic of beat-to-beat interval tachogram (RR) and systolic blood pressure (SBP) were extracted in time and frequency domains. A subset of these indices was selected using twelve subjects with an exhaustive search fused with a leave one subject out cross validation procedure. The selected indices were used to predict the p-BRS on the remaining four test subjects. A multivariate regression was used in all prediction steps. The algorithm achieved best prediction accuracy with only two features extracted from the deep breathing data, one from the frequency and the other from the time domain. The normalized L2-norm error was computed as 22.9% and the correlation coefficient was 0.97 (p=0.03). These results suggest that the p-BRS can be estimated from non-pharmacological indices computed from ECG and invasive BP data related to deep breathing.