Circadian Rhythm of Infarct Size and Left Ventricular Function Evaluated with Tissue Doppler Echocardiography in ST Elevation Myocardial Infarction.

BACKGROUND: We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI). METHODS: We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated. RESULTS: A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p=0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06:00-noon compared with period of noon-18:00 and 18:00-midnight (p=0.029 and p=0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9±7.3% versus 47.3±7.9%, p=0.018, and 7.6±1.4cm/s versus 8.2±1.6cm/s, p=0.003, respectively). CONCLUSIONS: This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06:00-noon period.

Effect of Weight Loss Induced by Intragastric Balloon Therapy on Cardiac Function in Morbidly Obese Individuals: A Pilot Study.

OBJECTIVE: The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients. SUBJECTS AND METHODS: A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure. RESULTS: The mean age of the study participants was 36 ± 10 years (range: 18-55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 ± 8 vs. 38 ± 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 ± 21 vs. 93 ± 17, p = 0.001 and 20 ± 6 vs. 14 ± 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 ± 1.9 vs. 7.7 ± 1.5, p = 0.002 and 0.57 ± 0.11 vs. 0.46 ± 0.06, p = 0.001, respectively). CONCLUSIONS: Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function.

The effect of slow coronary flow on right and left ventricular performance.

OBJECTIVE: To evaluate left and right ventricular functions using tissue Doppler echocardiography (TDE) and myocardial performance index (MPI) methods in patients with slow coronary flow (SCF) and to determine the relationship between these parameters and thrombolysis in myocardial infarction frame count in SCF patients. SUBJECTS AND METHODS: Thirty-five patients (20 males and 15 females) with SCF who underwent coronary angiography and 35 age- and sex-matched controls (14 males and 21 females) without SCF who underwent elective coronary angiography were enrolled in the study. Left ventricular (LV) and right ventricular (RV) functions were examined using conventional echocardiography and TDE. RESULTS: LV systolic myocardial velocity (Sm), early myocardial velocity (Em), late myocardial velocity (Am), and Em/Am ratio were similar in both the SCF and control groups; however, isovolumetric relaxation time (IRT) was higher in the SCF group compared to the control group (IRT: 99 ± 17 vs. 88 ± 20; p = 0.01). In patients with SCF, LV MPI was higher than in the control group, but this was not statistically significant (0.61 ± 0.11 vs. 0.56 ± 0.12; p = 0.07). The RV tricuspid annular velocities and MPI were similar in the SCF and control groups. CONCLUSION: This study showed that SCF affected LV functions echocardiographically and could cause partially reduced LV performance. In addition, SCF did not affect RV functions echocardiographically.

Fragmented QRS complexes are associated with increased left ventricular mass in patients with essential hypertension.

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent predictor of poor prognosis in patients with hypertension. In hypertensive hypertrophy, the pathophysiological mechanism is the accumulation of collagen in the myocardium. Fragmented QRS (fQRS) complexes are associated with myocardial fibrosis. METHODS: The study population included 90 patients with hypertension and a normal coronary angiogram. The fQRS was defined as the presence of an additional R wave (R'), notching of the R or S wave, or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery. Echocardiographic examinations were performed according to the recommendations of the American Society of Echocardiography. RESULTS: Forty-five patients who had fQRS and were suitable for the study criteria were compared with 45 age- and gender-matched patients who did not have fQRS according to demographic data and echocardiographic findings. The left ventricular (LV) mass index (g/m(2) ) was significantly higher (P < 0.001) in the group with fQRS. The wall thickness, diameter, volume, and ejection fraction (EF) were higher in this group (P < 0.001). Concentric and eccentric hypertrophy were also higher in this group (P < 0.001). In the logistic regression analysis, fQRS on ECG was an indicator of LVH in hypertensive patients (B = 0.064; P < 0.001; odds ratio = 1.066; 95% confidence interval = 1.041-1.092) CONCLUSION: The LV mass index of the hypertensive patients who had fQRS on their ECGs was significantly higher than that of the patients who did not, and fQRS on ECG was an important indicator of LVH in hypertensive patients.

The relationship between coronary sinus and impaired right ventricular myocardial performance index in mitral stenosis.

OBJECTIVES: We aimed to investigate whether coronary sinus (CS) dilatation develops in patients with mitral stenosis (MS) and to demonstrate its relationship with the global myocardial performance of the right ventricle (RV). METHODS: We enrolled 34 patients with MS who underwent echocardiography after exhibiting typical symptoms (31 female; mean age 41 ± 12 years) and 20 age- and sex-matched controls without MS who underwent echocardiography (16 female; mean age 38 ± 13 years). The RV myocardial performance index (MPI) was detected using tissue Doppler echocardiography (TDE), and maximum CS diameter was measured from the posterior atrioventricular groove in the apical four-chamber view during the ventricular systole. RESULTS: The RV MPI was significantly higher in the MS group compared to the control group (0.60 ± 0.11 vs. 0.41 ± 0.08, P < 0.001). Moreover, the maximum CS dimension was higher in the MS group compared to the control group (8.5 ± 1.1 mm vs. 6.5 ± 1.4 mm, P < 0.001). The maximum CS dilatation was positively correlated with the RV MPI (r = 0.691; P < 0.001). CONCLUSION: The RV MPI, which represents both systolic and diastolic functions, is increased in patients with MS and correlates with CS dilatation.

Optical Properties in a ZnS/CdS/ZnS Core/Shell/Shell Spherical Quantum Dot: Electric and Magnetic Field and Donor Impurity Effects.

A theoretical analysis of optical properties in a ZnS/CdS/ZnS core/shell/shell spherical quantum dot was carried out within the effective mass approximation. The corresponding Schrödinger equation was solved using the finite element method via the 2D axis-symmetric module of COMSOL-Multiphysics software. Calculations included variations of internal dot radius, the application of electric and magnetic fields (both oriented along z-direction), as well as the presence of on-center donor impurity. Reported optical properties are the absorption and relative refractive index change coefficients. These quantities are related to transitions between the ground and first excited states, with linearly polarized incident radiation along the z-axis. It is found that transition energy decreases with the growth of internal radius, thus causing the red-shift of resonant peaks. The same happens when the external magnetic field increases. When the strength of applied electric field is increased, the opposite effect is observed, since there is a blue-shift of resonances. However, dipole matrix moments decrease drastically with the increase of the electric field, leading to a reduction in amplitude of optical responses. At the moment impurity effects are activated, a decrease in the value of the energies is noted, significantly affecting the ground state, which is more evident for small internal radius. This is reflected in an increase in transition energies.

Cardiotrophin-1 plasma levels are increased in patients with diastolic heart failure.

BACKGROUND: Cardiotrophin-1 (CT-1) is a member of the interleukin (IL-6) family of cytokines and is increased in various cardiovascular diseases, including chronic heart failure. The aim of the study was to determine if plasma CT-1 is associated with diastolic heart failure (DHF) and to investigate the relationship between CT-1 and echocardiographic parameters. MATERIAL/METHODS: Fifty-seven consecutive patients (mean age 57 ± 8 years, 24 males) diagnosed with DHF in our clinic and 33 controls (mean age 55 ± 7 years, 12 males) were included in the study. All study participants underwent echocardiographic evaluation and blood samples were obtained. RESULTS: CT-1 and NT-proBNP values were significantly higher in DHF subjects than in controls (11.30 [8.09-16.51] vs. 17.5 [8.95-28.74] fmol/mL, P=0.017 and 64 [27.5-95] vs. 82 [55.5-241] pg/mL, P=0.009, respectively). The mitral peak velocity of early diastolic filling (E), mean ratio of E to early diastolic mitral annular velocity (E/Em), and the pulmonary capillary wedge pressure (PCWP) estimated from E/Em measurements were all significantly higher in the patient group (62.27 ± 14.69 vs. 75.67 ± 18.85 cm/sec, 6.40 ± 1.48 vs. 10.30 ± 3.48, and 10 [9-11] vs. 14[12-16] mmHg, P ≤ 0.001 for all). Lateral and septal Em were significantly lower in the patient group (10.69 ± 1.87 vs. 8.69 ± 2.00 cm/sec and 8.91 ± 1.22 vs. 6.65 ± 1.58 cm/sec, P<0.001 for both). CT-1 positively correlated with NT-proBNP (P=0.001, r=0.349), mean E/Em (P=0.003, r=0.307), and estimated mean PCWP (P=0.001, r=0.308). CONCLUSIONS: CT-1 is elevated in patients with DHF and is associated with NT-proBNP and estimated left ventricular filling pressures.

Coronary ectasia is associated with impaired left ventricular myocardial performance in patients without significant coronary artery stenosis.

OBJECTIVES: To determine both ventricular functions and tissue Doppler echocardiography (TDE)-derived myocardial performance index (MPI) in patients with coronary artery ectasia (CAE). SUBJECTS AND METHODS: Twenty-five patients with CAE (13 men; mean age 57 ± 9 years) and 25 age- and sex-matched controls without CAE (8 men; mean age 54 ± 10 years) were enrolled in the study. Left and right ventricular functions were detected using conventional echocardiography and TDE. RESULTS: Left ventricle-lateral wall (0.61 ± 0.17; 0.50 ± 0.10, p = 0.02), interventricular septum (0.66 ± 0.17; 0.52 ± 0.10, p = 0.007) and mean MPI (0.63 ± 0.15; 0.51 ± 0.09, p = 0.004) were increased in the CAE group compared to the control group. Right ventricular MPI was similar in both the CAE and control groups (0.58 ± 0.18; 0.52 ± 0.19, p > 0.05). CONCLUSION: The findings show that left ventricular MPI is different in CAE patients without obstructive coronary artery disease compared to the normal control group. Also in these patients, right ventricular MPI was similar to the control group.

Frequency of fragmented QRS on ECG is increased in patients with rheumatoid arthritis without cardiovascular disease: a pilot study.

Myocardial fibrosis causes the fragmentation of QRS complexes (fQRS) on ECGs. We hypothesized that the frequency of fQRS could be more common in patients with rheumatoid arthritis (RA) than in control subjects. A total of 56 patients with RA were compared with 35 age- and gender-matched fibromyalgia subjects for fQRS. The fQRS was defined as the presence of an additional R wave, or notching of the R or S wave, or the presence of fragmentation in 2 contiguous leads corresponding to the territory of a major coronary artery. Patients with bundle block on ECG and cardiovascular disease were excluded. Twenty-one patients (37.5%) in the RA group had fQRS, while two patients in the control group (5.7%) had fQRS (p = 0.001). No differences were found between the groups in terms of age, gender, or drug use. Duration of disease--years (interquartile range [IQR])--was 10 (8) in the fQRS (+) group, while it was 5 (2) in the fQRS (-) group (p < 0.001). Multivariate logistic regression analysis revealed that duration of disease was associated with the presence of fQRS (B = 1.5, odds ratio = 4.5, p = 0.004, 95% confidence interval = 1.6-12.7). We found that fQRS on ECG was more common in patients with RA without cardiovascular disease than in age- and gender-matched control subjects.

The effects of significant coronary stenosis and percutaneous coronary intervention on aortic stiffness.

OBJECTIVES: Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous coronary intervention (PCI). Our hypothesis was that AS might provide additional information about coronary hemodynamic status. In this context, we investigated the effects of coronary stenosis and PCI on AS. STUDY DESIGN: The study included 107 patients undergoing coronary angiography. The patients were divided into three groups based on the angiographic results: 39 patients with significant lesions (≥50%) formed the 'critical group' and 38 patients with nonsignificant lesions (<50%) formed the 'noncritical group'. The control group (30 patients) had normal angiograms. Aortic stiffness was determined using the carotid-femoral aortic pulse wave velocity (PWV) method. All patients in the critical group underwent successful PCI and repeat PWV measurements. RESULTS: All baseline characteristics were similar in the three groups except for the mean PWV, which was significantly higher (9.4±2.2 m/sec) in the critical group compared to the control group (5.7±1.1 m/sec) and the noncritical group (5.8±1.1 m/sec) (p<0.0001). The latter two groups had similar PWV values (p=0.6). After PCI, the mean PWV decreased significantly by 24.4% to 7.1±2.0 m/sec (p=0.002); however, it was still significantly higher than that of the control group (p<0.0001). In correlation analysis, PWV showed significant correlations with age (r=0.412, p=0.01), systolic blood pressure (r=0.342, p<0.01), and hemoglobin (r=-0.370, p=0.02). Multiple logistic regression analysis showed that PWV was a predictor for significant stenosis [Exp(B) 3.960, 95% CI 2.014-7.786]. CONCLUSION: Our findings suggest that significant coronary stenosis is associated with significantly increased AS and successful PCI improves AS to some extent.

Role of mitochondrial translation in remodeling of energy metabolism in ER/PR(+) breast cancer.

Remodeling of mitochondrial energy metabolism is essential for the survival of tumor cells in limited nutrient availability and hypoxic conditions. Defects in oxidative phosphorylation (OXPHOS) and mitochondrial biogenesis also cause a switch in energy metabolism from oxidative to aerobic glycolysis contributing to the tumor heterogeneity in cancer. Specifically, the aberrant expressions of mitochondrial translation components such as ribosomal proteins (MRPs) and translation factors have been increasingly associated with many different cancers including breast cancer. The mitochondrial translation is responsible for the synthesis 13 of mitochondrial-encoded OXPHOS subunits of complexes. In this study, we investigated the contribution of mitochondrial translation in the remodeling of oxidative energy metabolism through altered expression of OXPHOS subunits in 26 ER/PR(+) breast tumors. We observed a significant correlation between the changes in the expression of mitochondrial translation-related proteins and OXPHOS subunits in the majority of the ER/PR(+) breast tumors and breast cancer cell lines. The reduced expression of OXPHOS and mitochondrial translation components also correlated well with the changes in epithelial-mesenchymal transition (EMT) markers, E-cadherin (CHD1), and vimentin (VIM) in the ER/PR(+) tumor biopsies. Data mining analysis of the Clinical Proteomic Tumor Analysis Consortium (CPTAC) breast cancer proteome further supported the correlation between the reduced OXPHOS subunit expression and increased EMT and metastatic marker expression in the majority of the ER/PR(+) tumors. Therefore, understanding the role of MRPs in the remodeling of energy metabolism will be essential in the characterization of heterogeneity at the molecular level and serve as diagnostic and prognostic markers in breast cancer.

Heart rate variability and turbulence to determine true coronary artery disease in patients with ST segment depression without angina during exercise stress testing.

PURPOSE: ST segment depression without angina during an exercise stress test causes diagnostic problems, particularly in non-diabetic patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are used to evaluate the changes in cardiac autonomic functions and are also both decreased in patients with coronary artery disease. The aim of this study was determine the values of HRV and HRT that discriminate true coronary artery disease from false positive stress test results. METHODS: Ninety non-diabetic patients who underwent diagnostic coronary angiography (CA) due to suspected coronary artery disease after ST segment depression without angina during an exercise stress test were enrolled in the study. Prior to CA, 24 hour ambulatory electrocardiogram recordings were taken and HRV and HRT parameters were calculated. RESULTS: Patients were divided into three groups according to the severity of their coronary lesions: (group 1 normal, group 2 non-obstructive and group 3 obstructive. There were no differences among the groups with regards to age, sex, medical history, medications, systolic and diastolic blood pressures, body mass index, fasting glucose, anemia and thyroid status, lipid profile and creatinine clearance. HRV parameters and turbulence slope (TS) were significantly lower while turbulence onset (TO) was significantly higher in group 3 than groups 1 and 2. According to the cut-off values calculated using ROC analysis, SDNN≤69.63 msec, TO > 0.14%, and TS≤2.78 msec/RR have high diagnostic accuracy for predicting obstructive coronary artery disease. CONCLUSION: HRV and HRT parameters may provide additional information for discriminating between patients who do and do not truly need CA.

Heart rate variability and heart rate turbulence in hypothyroidism before and after treatment.

BACKGROUND: Cardiac autonomic dysfunction may develop in patients with clinical or subclinical thyroid hormone deficiency. Heart rate variability (HRV) and heart rate turbulence (HRT) are used for evaluating changes in cardiac autonomic functions and also used to provide risk stratification in cardiac and noncardiac diseases. The aim of this study is to evaluate cardiac autonomic functions before and 6 months after thyroid replacement therapy in patients with thyroid hormone deficiency. METHODS: Forty hypothyroid patients (mean age 48 ± 13, four male) and 31 healthy controls (mean age 51 ± 12, three male) were included in the study. Twenty-four hour ambulatory electrocardiogram recordings were taken using Pathfinder Software Version V8.255 (Reynolds Medical). The time domain parameters of HRV analysis were performed using the Heart Rate Variability Software (version 4.2.0, Norav Medical Ltd, Israel). HRT parameters, Turbulence Onset (TO), and Turbulence Slope (TS) were calculated with HRT! View Version 0.60-0.1 software. RESULTS: HRV and HRT parameters were decreased in the patient group (SDNN; P < 0.001, SDANN; P < 0.009, RMSSD; P = 0.049, TO; P = 0.035, TS; P < 0.001). After 6 months of thyroid replacement therapy, there were no significant changes observed in either HRV or HRT. CONCLUSIONS: Hypothyroidism may cause cardiac autonomic dysfunction. Treating hypothyroidism with L-thyroxine therapy does not effectively restore cardiac autonomic function. HRV and HRT can be used as to help monitor cardiovascular-related risk in this population.

Is diastolic dysfunction associated with atrial electrocardiographic parameters in Behçet's disease?

BACKGROUND: The impact of Behçet's disease (BD) on the vascular bed is highly important, as this condition may lead to heart failure from asymptomatic systolic and diastolic dysfunction. Our aim was to evaluate diastolic functions using new echocardiographic parameters and the correlation of these parameters with atrial electrocardiographic (ECG) indices in patients with BD. METHODS: 31 patients with BD and 31 healthy control subjects were enrolled to this study. Left ventricular (LV) diastolic functions were examined with conventional and tissue Doppler echocardiography. P-wave dispersion (PD) was calculated by measuring minimum and maximum P-wave duration values on the 12-lead surface ECG. The relationship between PD and echocardiographic parameters of diastolic dysfunction were investigated. RESULTS: The mitral inflow E/A ratio and diastolic myocardial velocity ratio (Em/Am) were lower in the BD group (P < 0.001 and P < 0.001, respectively). The E/Em ratio and left atrial volume index (LAVi) were higher in the BD group (P < 0.001 and P = 0.014, respectively) compared to healthy control subjects. P max and PD were significantly higher in the BD group (P < 0.001 and P < 0.001). PD correlated positively with the duration of BD. Also, PD correlated positively with LAVi and E/Em ratio, but negatively with E/A and Em/Am ratios. CONCLUSION: In this study, we demonstrated that LV diastolic functions are impaired in BD patients. Furthermore, P-wave abnormalities were demonstrated in BD patients and there was a significant correlation between PD and diastolic dysfunction.

A 1.5 cm-long unknown subconjunctival grass inflorescence misdiagnosed as relapsing conjunctivitis for one year.

Foreign bodies are usually detected at the first visit. However, they may be overlooked sometimes, especially in children, and may cause some clinical conditions including unilateral relapsing conjunctivitis. A five-year-old girl was presented to the emergency clinic of our hospital with epiphora, purulent discharge, eyelid swelling, and a foreign body feeling in her right eye. The symptoms had been present for one year, and the patient was treated for relapsing conjunctivitis. In slit lamp examination performed with difficulty because of the patient's lack of cooperation, a localized edema and erythema were observed under the right eyelid. An exploration under general anesthesia was planned, and a 1.5 cm-long subconjunctival grass inflorescence was removed. An unknown subconjunctival foreign body should be considered in each patient with relapsing conjunctivitis, especially in children, even in the absence of ocular trauma.

Atorvastatin given prior to electrical cardioversion does not affect the recurrence of atrial fibrillation in patients with persistent atrial fibrillation who are on antiarrhythmic therapy.

OBJECTIVE: In this study, our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation (AF) after electrical cardioversion (EC) in addition to antiarrhythmic therapy. SUBJECTS AND METHODS: 48 patients with persistent AF were included in this study. The patients were randomized to an atorvastatin 40-mg treatment group and a control group. Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC. EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin. Lipid and inflammatory parameters (high-sensitivity C-reactive protein, white blood cell count and fibrinogen level) were evaluated at the baseline and before EC. The endpoint of this study was electrocardiographically confirmed recurrence of AF of >10 min. RESULTS: There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups. Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values (174 ± 31 vs. 129 ± 25 mg/dl, p = 0.001, and 112 ± 23 vs. 62 ± 20 mg/dl, p = 0.001, respectively), while no significant change occurred in control patients (168 ± 26 vs. 182 ± 29 mg/dl, p = 0.07, and 99 ± 18 vs. 108 ± 26 mg/dl, p = 0.1, respectively). At the end of the 2-month follow-up period, 9 patients (20.5%) experienced AF recurrence, and there was no significant difference in AF recurrence rate between the treatment and control groups (26 vs. 13%; p = 0.2). CONCLUSION: Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy.

[The relationship between coronary collateral circulation and blood high-sensitivity C-reactive protein levels]. / Koroner kolateral dolasim ile serum yüksek duyarlikli C-reaktif protein düzeyleri arasindaki iliski.

OBJECTIVES: We evaluated the relationship between coronary collateral circulation (CCC) and blood high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic stable coronary artery disease. STUDY DESIGN: The study included 104 patients who underwent coronary angiography at least one month after acute coronary event and were found to have total coronary occlusion in at least one major coronary artery. Patients with the diagnosis of acute coronary syndrome within the past month, severe valve disease, systemic disease, systemic inflammatory disease, or a history of coronary surgery or percutaneous coronary intervention were excluded. Collateral circulation was graded according to the Rentrop classification. Grades 0 and 1 were defined as poor, grades 2 and 3 were defined as good CCC. Blood hs-CRP levels were measured 1 to 7 days before coronary angiography. RESULTS: According to the Rentrop classification, CCC was graded as 0 in 10 patients, 1 in 26 patients, 2 in 29 patients, and 3 in 39 patients. Sixty-eight patients (65.4%) had a good CCC, and 36 patients (34.6%) had a poor CCC. The two groups were similar with respect to age, sex, risk factors, medications, localization of the occluded coronary artery, and the number of occluded arteries. However, hs-CRP levels were significantly higher in patients with a poor CCC (median 5.42 mg/dl; range 2.3-9.8 mg/dl) compared to those with a good CCC (median 3.36 mg/dl; range 2.2-9.7 mg/dl, p=0.003). Logistic regression analysis showed that hs-CRP level was a significant predictor exerting an adverse effect on collateral development (ß=-320; odds ratio= 0.725; 95% confidence interval 0.587-0.894; p=0.003). CONCLUSION: Our findings suggest that high hs-CRP level is a significant predictor of poor collateral development in patients with chronic stable coronary artery disease.

Increased aortic pulse wave velocity in obese children.

OBJECTIVES: Obesity may start in childhood and obese children are more likely to grow up to be obese adults. Atherosclerosis is one of the most important complications of obesity. Pulse wave velocity (PWV), a noninvasive measure of arterial stiffness, is accepted to be an indicator of subclinical atherosclerosis. The aim of the study was to determine PWV in obese children. STUDY DESIGN: The study included 30 obese (12 boys, 18 girls; mean age 13 ± 2 years) and 30 lean children (13 boys, 17 girls; mean age 12.5 ± 1.7 years). Weight and height were measured and obesity was defined as body mass index (BMI) of greater than the 95th percentile for age. All the subjects underwent echocardiographic evaluation and blood samples were obtained. Pulse-wave velocity was calculated using the following equation: PWV (m/sec) = height-based aortic length (cm)/(100xtransit time [sec]). The latter was measured as the difference in the time of onset of two flows at the diaphragm and the aortic valve. RESULTS: Obese subjects had significantly higher blood pressure levels compared to the control group (p<0.001). The two groups were similar with respect to fasting glucose, hemoglobin, serum creatinine, and lipid levels. Among echocardiographic parameters, left ventricular end-diastolic dimension, interventricular septum thickness, posterior wall thickness, left ventricular mass index, left atrium dimension, and aortic root dimension were significantly increased in obese subjects compared to controls (p<0.01). Obese children had significantly higher PWV values than the controls (4.0 ± 0.8 vs. 3.3 ± 0.7 m/sec, p<0.001). A positive significant correlation was found between PWV and BMI (r=0.391, p=0.002). CONCLUSION: Our findings show that aortic PWV is increased in obese children, suggesting that obesity may cause subclinical atherosclerosis even at early ages.

The relationship between inflammation and slow coronary flow: increased red cell distribution width and serum uric acid levels.

OBJECTIVES: The underlying mechanism of slow coronary flow (SCF) has yet to be elucidated. Increased red cell distribution width (RDW) and uric acid level may be indicative of an underlying inflammatory state. We aimed to investigate RDW and serum uric acid levels in patients with normal coronary arteries and SCF without stenosis. STUDY DESIGN: The study included 46 consecutive patients (25 males, 21 females; mean age 54 ± 11 years) with angiographically normal coronary arteries but having SCF in all three coronary arteries. The control group consisted of 40 patients (18 males, 22 females; mean age 54 ± 9 years) with angiographically normal coronary arteries without SCF. In both groups, RDW and serum uric acid levels were measured and compared. RESULTS: In the SCF group, TIMI frame counts measured in the left anterior descending coronary artery, left circumflex coronary artery, and right coronary artery were significantly higher compared to the control group (p<0.05). Patients with SCF exhibited significantly higher RDW (13.4 ± 1.6% vs. 12.6 ± 1.2%, p=0.01) and serum uric acid levels (5.3 ± 1.6 mg/dl vs. 4.7 ± 1.3 mg/dl, p=0.01) compared to controls. In logistic regression analysis, uric acid [Exp(B)=1.612, 95% CI 0.206-5.35, p=0.021] and RDW [Exp(B)=1.496, 95% CI 0.403-4.72, p=0.030] were found as independent predictors of SCF. CONCLUSION: Our findings show that patients with SCF have significantly increased RDW and serum uric acid levels. This may help throw more light on the pathophysiological basis of SCF.