Assessment of palatal mucosal thickness and location of the greater palatine foramen using cone-beam computed tomography: a retrospective study.

OBJECTIVES: This study aimed to measure the palatal mucosal thickness and examine the location of the greater palatine foramen using cone-beam computerized tomography (CBCT). METHODS: In this study, cone-beam computed tomography (CBCT) images of the maxillary posterior region of 120 subjects were evaluated. The palatal mucosal thickness (PMT), palatal width and depth, and location of the greater palatine foramen (GPF) were determined on CBCT. The differences in the palatal mucosal thickness according to gender and palatal width/palatal depth were analyzed. The location of the GPF related to the maxillary molars was noted. RESULTS: The mean palatal mucosal thicknesses from the canine to the second molar teeth were 3.66, 3.90, 4.06, 3.76, and 3.92 mm, respectively. The mean PMT at the second premolar was statistically thicker than at other regions (p < 0,001). There was no relationship between PMT and gender. However, the palatal depth and width of the males were greater than females. (p = 0.004 and p = 0.014, respectively) PMT in the low palatal vault group had statistically higher compared to the high palatal vault group. (p = 0.023) Greater palatine foramen was mostly observed between second and third molar teeth. (48%). CONCLUSIONS: According to our results, first and second premolar regions can be preferable in soft tissue grafting procedures for safe and successful treatment outcomes. The measurement of the thickness of the palatal mucosa and the evaluation of the greater palatine foramen location before the surgical procedures are essential steps to harvest from the ideal donor site and to achieve optimal surgical outcomes.

Assessment of gingival thickness in the maxillary anterior region using different techniques.

OBJECTIVES: Gingival phenotype is closely related to treatment success and aesthetic results in the maxillary anterior region. Several methods were proposed to measure the dimensions of the gingival tissue. This study aimed to evaluate the gingival thickness using clinical and radiographic techniques and to explore the association between gingival thickness and gingival phenotypes classified by color-coded phenotype probes. MATERIALS AND METHODS: The gingival thickness of 86 periodontally healthy maxillary anterior teeth was assessed using transgingival probing (TGP) and cone-beam computed tomography (CBCT). The gingival phenotype was classified as thin, medium, thick, or very thick by transparency of the color-coded probes through the gingival sulcus. The labial alveolar bone thickness was measured on CBCT images. The keratinized tissue width (KTW) was recorded. RESULTS: Good to excellent agreement was found between TGP and CBCT regarding the thickness of the gingiva (p<0.001). There was a very high correlation between the phenotypes determined by color-coded probes and the gingival thickness measured by TGP (r=0.953, p<0.001). KTW was significantly higher in thick and very thick phenotype groups compared with thin phenotype group. CONCLUSION: Cone-beam computed tomography images and the probe transparency method with color-coded probes are reliable for identifying the gingival phenotype in the maxillary anterior region, based on comparisons to direct transgingival probing. CLINICAL RELEVANCE: The assessment of the gingival phenotype is essential, especially in the aesthetic zone, to obtain predictable and favorable clinical outcomes in various dental procedures. The newly introduced color-coded probes comprise a non-invasive and reliable method for this.

Impact of stage-grade of periodontitis and self-reported symptoms on oral health-related quality of life.

OBJECTIVES: The aim of the study was to investigate the impact of stage-grade of periodontitis and self-reported signs and symptoms on oral health-related quality of life. METHODS: The diagnosis of periodontitis was based on the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The Turkish version of Oral Health Impact Profile-14 (OHIP-14) was used to assess oral health-related quality of life (OHRQoL) and the participants were requested to state their symptoms associated with periodontal diseases. RESULTS: One hundred and sixty-six patients were included in the study with a mean age of 46.54 ± 9.24 years. The participants with Stage IV and Grade C periodontitis had the highest total OHIP-14 scores (median 20.00 [min.-max, 3.00-35.00] and median 18.50 (min.-max, 0.00-36.00]; respectively). The OHIP-14 scores (mean ± SD) were significantly associated with the symptoms of bleeding gums (13.64 ± 9.39), sore gums (18.00 ± 10.47), swollen gums (17.42 ± 10.91), bad breath (15.82 ± 9.44), loose teeth (20.00 ± 8.66) and drifting teeth (24.56 ± 8.46). CONCLUSIONS: This study demonstrates a significant association between OHRQoL and periodontitis. Stage-grade of periodontitis and its symptoms were associated with poor quality of life.

Prevalence of Carotid Artery Calcification on Digital Panoramic Radiographs in Hemodialysis Patients on Kidney Transplant Waiting List.

OBJECTIVES: The detection of carotid artery calcification at an early stage is important to reduce the effects of cardiovascular disease in patients undergoing hemodialysis. This study sought to evaluate the prevalence of carotid artery calcification from panoramic radiographs of patients who were undergoing hemodialysis and to assess the relationship between such calcification and certain medical and periodontal parameters. MATERIALS AND METHODS: We evaluated 120 panoramic radiographs from patients who were undergoing hemodialysis for the presence of carotid artery calcification. Full-mouth periodontal clinical and medical parameters were recorded, and patients were diagnosed on the basis of the new periodontal disease classification. Patient medical records from the same period (the same week) during which the panoramic radiographs were taken were also assessed. RESULTS: Among the 120 participating patients, pano - ramic radiographs from 27 patients (22.5%) showed a uni- or bilaterally radiopaque mass. Of the periodontal clinical parameters investigated for associations between patients with and without carotid artery calcification, there was only a significant difference shown for probing pocket depth (P = .017). No significant differences were found between the groups with and without carotid artery calcification with regard to any other medical or periodontal parameter. CONCLUSIONS: In our study group, suspected carotid artery calcifications were detected on panoramic radiographs in about one-fourth of total patients receiving hemodialysis. Because of the significant relationship found between probing pocket depth and carotid artery calcification, the presence of periodontal disease may be associated with calcifications in these patients. Dentists should maintain awareness in detecting these lesions when evaluating panoramic radiographs of patients undergoing hemodialysis.

Assessment of carotid artery calcifications on digital panoramic radiographs and their relationship with periodontal condition and cardiovascular risk factors.

OBJECTIVE: The main purpose of this study is to determine the presence of carotid artery calcification (CAC) detected on digital panoramic radiographs (DPRs) retrospectively and correlate the findings with cardiovascular risk factors including gender, age, smoking status, hypertension, diabetes, and hyperlipidemia, along with atherosclerotic cardiovascular disease and periodontal status. METHODS: This clinical study is registered at ClinicalTrials.gov as NCT04017078. DPRs, periodontal status and cardiovascular risk factors of 1,101 patients (576 males, 525 females) were evaluated. The patients were grouped based on whether CAC was detected in dental DPRs [CAC (+)] or not [CAC (-)]. Periodontal status was categorised as gingivitis, periodontitis, and gingivitis with reduced periodontium (periodontally stable patient). RESULTS: Out of 1,101 patients, whose mean age was 42.1 ± 15.5 years and 525 (47.7%) were female, 34 (3.1%) were diagnosed with CAC on DPRs. No significant difference was observed between groups considering gender, hypertension, diabetes, hyperlipidemia, smoking, and periodontal status. Patients aged 40-55 years (n = 398, 36.15%) and patients older than 55 years (n = 222, 20.16%) were associated with CAC (odds ratio = 4.49, 95% confidence interval = 1.65-12.17, P = 0.003; odds ratio = 4.41, 95% confidence interval = 1.33-14.61, P = 0.015, respectively). CONCLUSION: Among all parameters, only age exhibited significant correlation with an increased risk of carotid calcification. Further studies with prospective designs and larger study populations are needed.

Evaluation of patients' perception of gingival recession, its impact on oral health-related quality of life, and acceptance of treatment plan.

Objective: Gingival recessions (GR) may cause aesthetic and hypersensitivity complaints which might affect oral health-related quality of life (OHRQoL). The aim of this study was to evaluate the patients' awareness of their own GR, the impact of GR on OHRQoL and the acceptance of suggested treatment modalities.Materials and Methods: This cross-sectional study was conducted with 205 patients. The demographic variables were recorded and patients' perception of GR was questioned. Full-mouth examination was carried out and clinical parameters were recorded. Gingival recessions, GR related complaints were evaluated and GR treatments were suggested and acceptance were also recorded by the examiner. The patients filled out OHRQoL-United Kingdom (OHRQoL-UK) questionnaire regarding to their GR and were asked if GR have/would have impact on oral health and if the GR will/would get worsen. Data was analysed with independent t test and Mann-Whitney U test.Results: 4819 teeth were evaluated and 733 GR examined in 147 patients. Fifty-seven patients were unaware of their GR. A strong belief that GR have impact on oral health (88.78%) and GR will progress (86.34%) was detected. Acceptance of treatment was increased and non-invasive modalities were preferred if patients had complaints. The awareness of GR status increases and the misperception decreases the OHRQoL-UK scores. The results revealed that hypersensitivity decreases the OHRQoL-UK scores and aesthetic concerns and hypersensitivity decreases the OHRQoL-UK physical scores significantly (p < .05).Conclusions: The results indicated that the patients might be unaware of their GR and the GR related factors may lead to poorer OHRQoL.

Percutaneous coronary intervention increases microvascular resistance in patients with non-ST-elevation acute coronary syndrome.

AIMS: In the acute coronary syndrome setting, the interaction between epicardial coronary artery stenosis and microcirculation subtended by the culprit vessel is poorly understood. The purpose of the present study was to assess the immediate impact of percutaneous coronary intervention (PCI) on microvascular resistance (MR) in patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS AND RESULTS: Thirty-eight patients undergoing PCI for NSTEMI were recruited consecutively. Culprit lesions were stented over a Doppler and pressure-sensor-equipped guidewire. In the presence of epicardial stenosis, MR was calculated by taking collateral flow, as measured by the coronary wedge pressure, into consideration. After removal of epicardial stenosis, MR was calculated simply as distal coronary pressure divided by average peak velocity. When collateral flow was incorporated into the calculation, MR increased significantly from 1.70 ± 0.76 to 2.05 ± 0.72 (p=0.001) after PCI in the whole population. Periprocedural changes (Δ) in absolute values of MR and troponin T correlated significantly (r=0.629, p=0.0001). In patients who developed periprocedural myocardial infarction, MR increased significantly after PCI (1.48 ± 0.73 versus 2.28 ± 0.71, p<0.001). Nevertheless, removal of the epicardial lesion did not change MR in patients without periprocedural MI (1.91±0.73 versus 1.81±0.67, p=0.1). CONCLUSIONS: When collateral flow is accounted for, removal of epicardial stenosis increases MR in patients with NSTEMI undergoing PCI.

Effect of cigarette smoking on platelet aggregation.

BACKGROUND: Cigarette smoking may increase platelet aggregation and cause atherothrombotic cardiovascular events. We aimed to investigate the impact of cigarette smoking on platelet function in patients with ischemic coronary heart disease (CHD). METHODS: Twenty patients with ischemic stable CHD under aspirin therapy (300 mg/d), who continue to smoking despite all warnings, and 20 nonsmokers with CHD are enrolled in the study. Platelet function is studied at the morning, before and 15 minutes after the first cigarette, by the Platelet Function Analyzer (PFA)-100, with collagen and epinephrine and collagen and adenosine diphosphate cartridges. Post aspirin platelet hyperactivity is defined as having a closure time (CT) shorter than 186 seconds despite regular aspirin intake. Serial CT measurements are analyzed by paired samples t test. RESULTS: Persistent platelet activity was present in 4 smoker (20%) and 3 nonsmoker (15%) patients at the beginning. Platelet activity measured by the PFA-100 is been increased significantly after cigarette smoking (P = .004). Shorter CTs were determined after smoking in all patients with and without baseline persistent platelet activity, and 4 more participants became aspirin nonresponder (P = .004). No significant differences in demographic, hematological, and biochemical parameters were determined between aspirin responders and nonresponders. CONCLUSIONS: We determined that cigarette smoking may increase platelet aggregation in patients with ischemic CHD in an aspirin nonresponsive manner. Our results emphasize the importance of quitting cigarette smoking in patients with CHD.

Cholesteryl ester transfer protein Taq1B polymorphism in an angiographically assessed Turkish population: no effects on coronary artery disease risk.

BACKGROUND: Taq1B polymorphism of cholesteryl ester transfer protein (CETP) is believed to associate with high-density lipoprotein-cholesterol (HDL-C) levels and may alter the susceptibility to atherosclerosis. AIM OF THE STUDY: This study investigated the effects of Taq1B polymorphism on HDL-C and coronary artery disease (CAD) risk in angiographically defined CAD patients. METHODS: One hundred thirty-five CAD patients and 112 healthy controls were screened for the CETP Taq1B genotype and plasma lipids. RESULTS: The genotype frequency of CAD patients and controls were similar. The HDL-C levels of all genotypes in the CAD group were significantly lower than the corresponding controls. Smoking and plasma triglycerides were the predictors of the HDL-C level in B1B1 bearers, whereas the subjects with a polymorphic B2 allele were affected by smoking and sex. CONCLUSION: CETP Taq1B polymorphism neither plays a role in determining HDL-C levels nor is a useful predictor of the risk of CAD.

The accuracy of deceleration time of diastolic coronary flow measured by transthoracic echocardiography in predicting long-term left ventricular infarct size and function after reperfused myocardial infarction.

AIMS: Assessment of microvascular function after reperfused acute myocardial infarction (AMI) provides important insights for myocardial reperfusion and facilitates prediction of long-term left ventricular (LV) function and clinical outcome. In this study, we examined microvascular integrity 48 h after successful primary percutaneous coronary intervention (PCI) and compared predictive accuracy of the intracoronary pressure-wire- and transthoracic Doppler echocardiography-based parameters in the estimation of long-term LV infarct size and function. METHODS AND RESULTS: The study group consisted of 30 anterior AMI patients who were treated successfully with primary PCI. Two days after primary PCI, microvascular integrity was evaluated. Coronary flow reserve (CFR), collateral flow index (CFIp), coronary wedge pressure (CWP), and index of microvascular resistance (IMR) were determined using intracoronary pressure wire. Deceleration time of coronary diastolic flow (DDT) was measured using transthoracic echocardiography. At 6 months, coronary angiography, echocardiography, and infarct size measurement were performed. Area under the curve, sensitivity, and specificity of the indices of microvascular perfusion in the prediction of late-term infarct size were as follows: IMR (0.68 ± 0.15, 69%, 60%), CFR (0.67 ± 0.10, 66%, 59%), CWP (0.69 ± 0.12, 70%, 72%), CFIp (0.64 ± 0.10, 65%, 78%), and DDT (0.68 ± 0.16, 69%, 79%). All of the microvascular perfusion indices, which have been used in this study, had comparable sensitivity and specificity in the prediction of long-term ejection fraction. There were no significant differences between areas under the curve of microvascular perfusion indices in the prediction of long-term infarct size and ejection fraction. CONCLUSION: As a non-invasive parameter, DDT was found to be as accurate as the invasive parameters of microvascular function in estimating long-term infarct size and LV function. Thus, simply measuring DDT in the reperfused infarct-related artery might provide useful and reliable estimate for early risk stratification.

Impact of myocardial acceleration during isovolumic contraction in evaluating subclinical right ventricular systolic dysfunction in type 2 diabetes mellitus patients.

AIM: In diabetes mellitus (DM) patients, left ventricular dysfunction is widely evaluated and established by conventional diagnostic methods, whereas right ventricular (RV) function is not as sufficiently evaluated. The aim of this study is to assess the preclinical effects of DM on RV function by using novel Tissue Doppler Imaging (TDI)-derived indices. METHODS: The study included 96 patients with type II DM [60 with DM only and 36 patients with coexisting DM and hypertension (DMHT)] and 40 healthy controls. Conventional parameters and TDI-derived systolic velocities of tricuspid annulus [isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), RV Tei index] were measured. RESULTS: TDI-derived RV IVA was significantly lower in both DM and DMHT patients compared to controls indicating subclinical impairment in RV systolic function in the study patients (P = 0,0001). However RV IVA was similar in DM and DMHT subgroup supporting RV systolic impairment in DM was independent from HT. In correlation analysis, RV IVA was significantly correlated with the existence of diabetic nephropathy (r =-0,38; P = 0,003), retinopathy (r =-0,35; P = 0,006), insulin resistance (r =-0,52; P = 0,0001). CONCLUSIONS: Diabetes is associated with subclinical RV systolic dysfunction, regardless of coexisting hypertension. Tissue Doppler-derived IVA; is a novel, non-invasive parameter which may be used in early detection of RV systolic dysfunction in patients with DM.

Concurrent microvascular and infarct remodeling after successful reperfusion of ST-elevation acute myocardial infarction.

BACKGROUND: Connection between the course of microvascular and infarct remodeling processes over time after reperfused ST-elevation acute myocardial infarction has not been fully elucidated. The aim of this study is to investigate the association of temporal changes in hemodynamics of microcirculation in the infarcted territory and infarct size (IS) after primary percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction. METHODS AND RESULTS: Thirty-five patients admitted with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention were enrolled in the study. Coronary flow reserve (CFR), index of microvascular resistance (IMR), and IS were assessed 2 days after primary percutaneous coronary intervention and at the 5-month follow-up. The predictors of the 5-month IS were the baseline values of IS (beta=0.6, P<0.001), IMR (beta=0.280, P=0.013), and CFR (beta=-0.276, P=0.017). There were significant correlations between relative change in IS and relative change in measures of microvascular function (IS and CFR [r=-0.51, P=0.002]); IS and IMR ([r=0.55, P=0.001]). In multivariate model, relative changes in IMR (beta=0.552, P=0.001) and CFR (beta=-0.511, P=0.002) were the only predictors of relative change in IS. In patients with an improvement in IMR >33%, the mean IS decreased from 32.3+/-16.9% to 19.3+/-14% (P=0.001) in the follow-up. Similarly, in patients with an improvement in CFR >41%, the mean IS significantly decreased from 29.9+/-20% to 15.8+/-12.4% (P=0.003). But in patients with an improvement in IMR and CFR, which were below than the mean values, IS did not significantly decrease during the follow-up. CONCLUSIONS: Improvement in microvascular function in the infarcted territory is associated with reduction in IS after reperfused ST-elevation acute myocardial infarction. This link suggests that further investigations are warranted to determine whether therapeutic protection of microvascular integrity results in augmentation of infarct healing.

Impact of genetic polymorphisms on platelet function and aspirin resistance.

Genetic polymorphisms may affect platelets' responses to the antiplatelet therapy. Our aim was to determine the role of genetic polymorphisms on aspirin resistance in patients with coronary heart disease (CHD). A total of 126 consecutive patients (35-85 years old, 32% women) with chronic stable CHD was enrolled in the study. Platelet function assays were realized by the platelet function analyzer (PFA)-100 with collagen and epinephrine (Col/Epi) and collagen and adenosine diphosphate (Col/ADP) cartridges. Aspirin resistance was defined as having a closure time of less than 186 s with Col/Epi cartridges despite regular aspirin therapy. Factor V, prothrombin, factor XIII, beta-fibrinogen, plasminogen activator inhibitor I (PAI-1), glycoprotein IIIa, methylene tetrahydrofolate reductase, ACE and ApoB gene polymorphisms were determined by three consecutive steps: isolation and amplification of DNA and reverse hybridization. We determined that 30 patients (23.8%) had aspirin resistance by the PFA-100. Mean closure time measured with the Col/ADP cartridges was 74 +/- 12 s (51-104 s). Ten of the 30 patients with aspirin resistance were women (33.3%). Genetic polymorphisms were determined in 30 aspirin-resistant and 17 aspirin-sensitive patients. No statistically significant relationship was determined between aspirin resistance and the genetic panel. In our study we did not determine a significant relationship between the aspirin resistance and factor V, prothrombin, factor XIII, beta-fibrinogen, PAI-1, glycoprotein IIIa, methylene tetrahydrofolate reductase, ACE and ApoB gene polymorphisms.

Infarct remodeling process during long-term follow-up after reperfused acute myocardial infarction.

BACKGROUND: After acute myocardial infarction (AMI), the recovery of perfusion in infarct area may lead to significant spontaneous infarct size (IS) reduction during the subsequent period. The natural course of infarct-healing process after reperfusion therapy has not been fully elucidated. In this study, we investigated the time course of the spontaneous infarct-healing process in patients with reperfused AMI. METHODS AND RESULTS: Fifty-two patients with AMI who underwent primary percutaneous intervention were included. IS was measured with single-photon emission tomography using Bull's eye method at 4th day, at 5th, and at 10th months. IS was expressed as a percentage of the total myocardium. IS decreased by 33.6% at 5th month when compared with 4th day IS (from 26.3% +/- 18.8% to 17.5% +/- 12.9%, P < 0.001, n = 44). At 10th month, mean IS decreased by 21% when compared with 5th month IS (from 15.89% +/- 12.65% to 12.53% +/- 9.35%, P = 0.007, n = 31) and 49% when compared with 4th day IS (24.02% +/- 17.67% to 12.53% +/- 9.35%, P < 0.001). CONCLUSION: Significant endogenous recovery of perfusion in the infarct area occurs at the long term in patients with reperfused AMI. Infarct healing is a dynamic and ongoing process and decrease in IS continues long term after reperfused AMI.

Early diagnosis of right ventricular systolic dysfunction by tissue Doppler-derived isovolumic myocardial acceleration in patients with chronic obstructive pulmonary disease.

OBJECTIVES: The aim of the study was to assess validity of tissue Doppler imaging (TDI)-derived right ventricular (RV) myocardial systolic velocities in early detection of RV systolic dysfunction in chronic obstructive pulmonary disease (COPD). METHODS: Ninety COPD patients (50 pure COPD and 40 with right heart failure [RHF]) and 40 controls were enrolled. Respiratory function tests, conventional echocardiographic parameters, and TDI-derived isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak velocity during systolic ejection (Sa) were measured. RESULTS: All the TDI-derived RV systolic velocities were impaired in COPD (P = 0.0001) compared to controls. IVA was the only parameter that could distinguish the patients with pure COPD and COPD with RHF (P = 0.0001). IVA was found to be significantly correlated with FEV1 (r = 0.41, P = 0.0001), FEV1/FVC (r = 0.43, P = 0.0001), pulmonary artery pressure (r =-0.34, P = 0.001), pulmonary flow acceleration time (r = 0.48, P = 0.0001), and tricuspid annular systolic excursion (r =-0.41, P = 0.0001). In addition, IVA < or = 2.7 m/sec(2) was able to predict COPD patients from controls with 81% sensitivity, 98% specificity and IVA < or = 1.9 m/sec(2) predicted COPD patients accompanied by RHF with 82% sensitivity, 77% specificity from patients without RHF. CONCLUSIONS: TDI-derived RV IVA is a novel, noninvasive echocardiographic index which may be used in the assessment of subclinical RV dysfunction in patients with COPD.

Association of cholesteryl ester transfer protein -629C > A polymorphism with high-density lipoprotein cholesterol levels in coronary artery disease patients.

In Turkish population, plasma HDL-C levels were found to be lower than in any other country and it is suggested that this is associated with genetic origin. The cholesteryl ester transfer protein (CETP) -629C > A polymorphism is associated with lower plasma CETP concentration, with increased HDL-C level. In the present study, the frequency of -629C > A polymorphism in patients with coronary artery disease (CAD) was investigated and the effect of genotype on HDL-C was evaluated in a Turkish population. For this aim CETP -629C > A polymorphism was studied in angiographically documented CAD patients and healthy controls. There was no statistical significance in the distribution of genotypes between patients and controls. Although A allele carriers with CAD had significantly lower HDL-C levels than controls, plasma lipid levels showed no difference according to the genotypes. Adjustment by a logistic regression model predicting CAD status through HDL-C and including some risk factors as covariate indicated that the HDL-C doesn't have a significant association with CAD risk in CA and AA genotype carriers. Smoking, gender and hypertension were the common predictors for the HDL-C levels in CA and AA carriers. Although HDL-C appeared to be the only significant predictor of CAD in our study groups, the contribution of CETP -629C > A polymorphism to the alterations in HDL-C level appears to be weak to mention a protective effect of this polymorphism for CAD. In conclusion, the findings of the present study indicate that the CETP -629C > A polymorphism is not among the determinants of the coronary artery disease in Turks.

Effect of intracoronary streptokinase administered immediately after primary percutaneous coronary intervention on long-term left ventricular infarct size, volumes, and function.

OBJECTIVES: The purpose of this study was to investigate the reflections of the improvement in microvascular perfusion provided by adjuvant intracoronary streptokinase (ICSK) on late-phase infarct size and left ventricular volumes and functions. BACKGROUND: It has been shown that ICSK given immediately after primary percutaneous coronary intervention (PCI) improves myocardial perfusion in the early days of ST-segment elevation acute myocardial infarction. METHODS: Ninety-five patients undergoing primary PCI were randomized to ICSK 250 kU (n = 51) or no additional therapy (n = 44). Two days later, coronary hemodynamic indexes were measured to evaluate tissue-level perfusion. After 6 months, angiography, echocardiography, and technetium-99m single-photon emission computed tomography (SPECT) were performed. RESULTS: At 2 days, all indexes of microvascular function were significantly better in the ICSK group than in the control group, including coronary flow reserve (2.5 vs. 1.7, p < 0.001) and index of microvascular resistance (20.2 vs. 34.2, p < 0.001). At 6 months, infarct size (22.7% vs. 32.9%; p = 0.003) and left ventricular end-systolic (41.1 ml vs. 60.9 ml; p = 0.009) and end-diastolic volumes (95.5 ml vs. 118.3 ml; p = 0.006) were significantly smaller, and the ejection fraction was significantly higher (57.2% vs. 51.8%; p = 0.018) in the ICSK group compared with the control group. CONCLUSIONS: In this study, it has been demonstrated that low-dose ICSK given immediately after primary PCI significantly limits long-term infarct size and preserves left ventricular volumes and functions. (Effect of Complementary Intracoronary Streptokinase Administration Immediately After Primary Percutaneous Coronary Intervention on Microvascular Perfusion and Late Term Infarct Size in Patients With Acute Myocardial Infarction; NCT00302419).

Effect of high dose statin therapy on platelet function; statins reduce aspirin-resistant platelet aggregation in patients with coronary heart disease.

BACKGROUND: Current evidence supports the preventive role of statins on platelet aggregation in patients with coronary heart disease. AIM: Our aim was to determine the effects of aggressive statin therapy on platelet function in patients with coronary heart disease. MATERIAL AND METHODS: A total of 178 consecutive patients (37-68 years old, 35.9% women) with stable coronary artery disease (CAD) was enrolled in the study. Platelet function assays were realized by the Platelet Function Analyzer (PFA)-100 with collagen and epinephrine (Col/Epi) and collagen and ADP (Col/ADP) cartridges. Aspirin resistance was defined as having a closure time (CT) of <186 s with Col/Epi cartridges despite regular aspirin therapy. A statin therapy protocol applied to the patients with aspirin resistance for 3 months. RESULTS: We determined that 20 (11.2%) of patients had aspirin resistance by the PFA-100. Mean closure time measured with the Col/ADP cartridges was 83 +/- 18 s (53-162 s). Of the patients 12 were not on a statin therapy and eight were taking 10 mg daily atorvastatin. After 3 months of 40 mg daily atorvastatin therapy 13 subjects with aspirin resistance became aspirin sensitive by PFA-100 (P < 0.0001). There was also a significant decrease in total and LDL cholesterol levels and an increase in HDL cholesterol at the third month of statin therapy (P < 0.0001 for all). CONCLUSION: Statin therapy reduced the in vitro aspirin resistance in 65% of the patients after a therapy of 3 months. Further studies are needed to elucidate the mechanism of statins' effects on platelet reactivity.

Intraaortic balloon occlusion during refractory cardiac arrest. A case report.

Despite recent advances in its management, the outcome from cardiac arrest is often poor despite appropriate cardiopulmonary resuscitation (CPR). The coronary perfusion pressure (CPP) achieved during CPR is associated with successful return of spontaneous circulation (ROSC). Continuous balloon occlusion of the descending aorta is an experimental method that can occlude the 'unnecessary' part of the circulation, thus diverting generated pressure and blood flow to the heart and brain. We present a case report with a patient unresponsive to standard CPR in which constant intraaortic balloon occlusion achieved ROSC and successful survival.