Subclinical myocardial dysfunction in patients with complete recovery from peripartum cardiomyopathy: a long-term clinical strain-echocardiographic study.

PURPOSE: The aim of this study was to assess long-term left ventricular (LV) systolic function using 3D speckle tracking echocardiography in patients with complete LV recovery following peripartum cardiomyopathy (PPCM). METHODS: A total of 20 PPCM patients who exhibited LV recovery (ejection fraction ≥50%) in the follow-up period and 20 age-matched, healthy women were included in the study. Standard 2D echocardiographic examinations were performed. Global longitudinal strain and global circumferential strain were analyzed. RESULTS: Age, weight, body surface area, smoking, heart rate, and systolic and diastolic blood pressure were similar in both groups. Echocardiographic examination showed no significant difference between both groups. Only the global longitudinal strain (18.1 ± 2.7 vs 20.16 ± 1.7, p = 0.02) and global circumferential strain (22.1 ± 2.9 vs 24.4 ± 1.19, p = 0.01) were significantly lower in PPCM patients. The lowest values for longitudinal strain belonged to the basal and mid regions of anterior, anteroseptal and lateral walls in the PPCM patients. CONCLUSION: Subclinical myocardial damage may persist in PPCM patients with full LV systolic recovery. 3D Speckle Tracking strain analysis is a useful method for detecting subtle myocardial dysfunction.

Association of ectatic non-infarct-related artery with 1-month stent thrombosis in patients with ST elevation myocardial infarction.

BACKGROUND: Ectatic infarct-related artery (IRA) has been shown to be associated with higher thrombus burden, no-reflow, stent thrombosis (ST) and major adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). The effect of ectatic non-IRA on ST without ectatic IRA is not known. We aimed to assess the effect of ectatic non-IRA presence on ST within 1 month after primary percutaneous intervention (pPCI) in patients with STEMI. METHODS: A total of 1541 patients with a diagnosis of STEMI and underwent pPCI between 2015 and 2020 were retrospectively included in the study. Patients with and without 1 month ST were compared. Penalised logistic regression method was used to assess the association between ST and candidate predictors due to the risk of overfitting. RESULTS: Median age of the study group was 56.5 (48.7 to 67.2) years. The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, ectatic non-IRA presence and use of tirofiban were significantly higher in the ST group (18.2±9.9 vs 15.1±9.9, p=0.03; 25% vs 7.2%, p<0.001; 54.2% vs 30.5%, p<0.001; respectively). Significantly higher thrombus aspiration (14.3% vs 6.7%, p=0.03) and lower stent implantation (67.7% vs 84%, p<0.001) rates were observed in ectatic IRA group compared with ectatic non-IRA group. In multivariable analysis, ectatic non-IRA presence was independently associated with 1-month ST (OR 4.01, 95% CI 1.86 to 8.63, p=0.01). CONCLUSION: Ectatic non-IRA presence without ectatic IRA in patients with STEMI increases the risk of ST within the first month of pPCI.

Spontaneous Right Coronary Artery Rupture and Acute Cardiac Tamponade in Behçet's Disease.

Coronary involvement in Behçet's disease is extremely rare and it can bring devastating consequences when it occurs. In this report, we present a 29-year-old male patient with Behçet's disease who developed rapidly changing and progressive coronary artery involvements under medical treatment.

Severity of periodontitis in patients with isolated coronary artery ectasia.

The concept that coronary artery ectasia (CAE) is an inflammatory-related disease has been increasingly recognized. Periodontitis induced low-grade chronic systemic inflammation has been shown to be associated with cardiovascular diseases. The aim of the present study was to evaluate the association between periodontitis and CAE.Thirty-two patients with isolated CAE, and 28 age, sex and smoking status-matched subjects with normal coronary arteries (NCA) underwent full dental examinations. Periodontal disease was evaluated using the following clinical parameters; number of remaining teeth, plaque index (PI), gingival index (GI), bleeding on probing (BOP), and pocket depth (PD).Cases and controls did not differ according to their baseline characteristics and prevalence of traditional cardiovascular risk factors. Patients with isolated CAE had higher periodontal indices when compared to subjects with NCA (PD: 3.6 ± 1.26 mm versus 2.3 ± 0.79 mm; GI: 2.29 ± 0.86 versus 1.43 ± 1.19; BOP (%): 52.18 ± 20.1 versus 27.8 ± 10.9, P < 0.001, P < 0.05 and P < 0.05, respectively). Moreover, in multivariate analysis higher values for PD were found to be significant predictors for the likelihood of having coronary ectasia.The results of the present study demonstrate for the first time that there is an association between periodontitis and isolated CAE.

Echocardiographic assessment of right ventricular function before and after surgery in patients with pectus excavatum and right ventricular compression.

BACKGROUND: We aimed to evaluate the effect of surgical repair on right ventricular (RV) function in patients with pectus excavatum (PE) and RV compression by Doppler echocardiography. MATERIALS AND METHODS: Twenty-three patients who were admitted to our hospital for surgical correction of PE between 2009 and 2012 were included in the study. After transthoracic echocardiographic evaluation, 16 patients with RV compression were enrolled. All patients were males (100%) with a mean age of 20.5 ± 5.6 years. Transthoracic echocardiography was repeated 1 month after surgery. Echocardiographic evaluation included the assessment of RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), pulsed tissue Doppler systolic velocity (S'), RV isovolumic acceleration (RV IVA), systolic pulmonary artery pressure, left ventricular (LV) ejection fraction, and myocardial performance indexes of both the right and the left ventricles (Tei index). RESULTS: Following the surgery, the RV end-diastolic diameter, TAPSE, S', and RV IVA were found to be significantly increased in patients with PE. In addition, RV and LV Tei index significantly improved after surgical correction. CONCLUSIONS: RV function significantly improved after corrective surgery. Quantitative echocardiographic examination provides accurate estimation when deciding for corrective surgery and also should be used in the assessment of postoperative improvement.

Cardiovascular effects of abduction shoulder sling in elderly patients; is it really safe?

OBJECTIVE: The purpose of the prospective study is to investigate the cardiovascular effects of abduction shoulder sling (ASS) in elderly patients who underwent rotator cuff surgery. METHODS: The study included 49 consecutive patients older than 50 years (mean 59.3 ± 8.2 years) who underwent arthroscopic rotator cuff repair surgery and used ASS in postoperative period. All cases underwent Holter electrocardiographic monitoring before (24 h) and after (48 h) the operation. The Holter findings were read by an experienced cardiologist and a pause of longer than 3 s and heart rate of <40 bpm was evaluated as significant bradycardia. RESULTS: One patient (61-year-old male) described feeling faint (presyncope) which was confirmed with the Holter finding of a pause more than 3 s which occurred in the day time. Two other patients (52-year-old male, and 62-year-old female) reported severe dizziness (hypotensive attack) which required admission to a general practitioner. However, Holter findings were normal in these patients. These three cases were referred to cardiology department for evaluation of carotid hypersensitivity syndrome (CSH). CSH was confirmed with tests made with provocative maneuvers in a sitting position. CSH was defined as at least 3 s of asystole (cardio-inhibitor type) during carotid massage or systolic blood pressure falling below 50 mmHg (vaso-depressor type). All three patients were obese patients and BMI was higher than 30. CONCLUSIONS: ASS may trigger CSH in short necked and obese patients by exerting mechanical stimulation to the carotid sinus. These patients should be informed about symptoms and signs of CSH and educated on the proper use of ASS and correct positioning of shoulder strap. CSH should be kept in mind in patients who present with dizziness, presyncope and palpitation during the postoperative period.

Oxidative stress and severity of coronary artery disease in young smokers with acute myocardial infarction.

BACKGROUND: Cigarette smoking increases the oxidative stress mediated vascular dysfunction in young adults. We aimed to investigate the relation between the oxidative stress indices and coronary artery disease (CAD) severity in young patients presenting with acute myocardial infarction (AMI). METHODS: Young patients (aged 〈 35 years) who were admitted consecutively to our hospital with a diagnosis of AMI were included in the study. Age matched healthy subjects were selected as controls. Oxidative stress indices including lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase (PON) and arylesterase (ARE) activities were measured in serum. CAD severity was assessed by calculating the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Study) score. We analyzed the association between the oxidative indices and CAD severity. RESULTS: Forty two young patients were admitted to the hospital with AMI (age 32.4 ± 2.6 years; 39 males, 3 females). Current and heavy smoking was commonly observed among the patients (79%). All patients underwent emergency coronary angiography. Twenty-eight healthy subjects were selected as controls. Patients had significantly higher OSI and TOS levels (median, interquartile range) [0.44 (0.26-1.75) vs 0.25 (0.22-0.30), p < 0.001 and 6.0 (4.4-20.8) vs 4.1 (3.7-4.6), p < 0.001], respectively, and lower TAS and LOOH levels [1.6 ± 0.1 vs 1.7 ± 0.1, p = 0.02 and 3.0 ± 0.8 vs 3.6 ± 0.4, p = 0.001], respectively, compared to the control group. CAD severity correlated positively with OSI (r = 0.508, p = 0.001) and TOS levels (r = 0.471, p = 0.002). Subjects with an intermediate to high SYNTAX score (≥ 22) demonstrated significantly higher OSI (median, interquartile range) [0.40 (0.34-1.75) vs 0.34 (0.26-0.68), p = 0.01] and TOS [6.9 (4.4-20.8) vs 5.8 (4.5-11.4), p = 0.01] levels compared to subjects with low SYNTAX score. CONCLUSIONS: Oxidative stress is an important contributor to CAD severity among young smokers. Elevated OSI and TOS levels reflect disease severity and vascular damage related to heavy smoking in early onset CAD.

[Coronary artery ectasia: clinical and angiographical evaluation]. / Koroner arter ektazisi: klinik ve anjiyografik degerlendirme.

OBJECTIVES: We investigated the prevalence, distribution, risk factors, and prognosis of coronary artery ectasia (CAE) in patients undergoing coronary angiography for suspected coronary artery disease (CAD). STUDY DESIGN: Of 4,119 patients undergoing elective coronary angiography between 2003 and 2005, 173 patients (139 males, 34 females; mean age 61+/-11 years) had CAE, with a prevalence of 4.2%. Distribution of CAE was made according to the classification of Markis et al. The results were compared with those of 145 control patients (115 males, 30 males; mean age 61+/-10 years) who had CAD but not CAE. Following coronary angiography, treatment was designed as aortocoronary bypass (n=3), percutaneous coronary intervention (n=36), and medical therapy (n=98). The mean follow-up was 34.2+/-2.5 months. RESULTS: Among CAE patients, there was a marked male preponderance with 80.3%. Coronary ectasia was isolated in 46 patients (26.6%) and was associated with significant coronary artery stenoses in 127 patients (73.4%). The only significant difference with the control group with respect to baseline features was the higher frequency of hypertension in the CAE group (p=0.002). Coronary ectasia involved a single vessel in 67.1%, two vessels in 24.9%, and three vessels in 8.1%, with the right coronary artery being the most common localization (50.9%). The diameters of ectatic coronary arteries ranged from 3.2 mm to 9.7 mm (mean 5.6 mm). According to the classification of Markis et al., the majority of patients (64.2%) had type IV ectasia. In multiple regression analysis, hypertension was independently associated with CAE (OR: 0.378; 95% CI: 0.211-0.678; p=0.001). Mortality occurred in nine patients (5.2%). The annual mortality rates were 1.5%, 2.1%, and 2.9% with medical therapy, percutaneous coronary intervention, and aortocoronary bypass, respectively. CONCLUSION: Our findings suggest that further prospective studies focus on the dependent relationship between hypertension and CAE, and on marked coexistence of CAD and CAE.