Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis.

AIM: To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS). METHOD: Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. RESULTS: CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P = 0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P = 0.08). The anti-tumor necrosis factor (TNF)-α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti-TNF-α group as compared to the conventional therapy group (P < 0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P < 0.001). CONCLUSION: Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti-TNF-α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels.

Left ventricle hydatid cyst mimicking acute coronary syndrome.

Cardiac echinococcosis rarely mimics acute coronary syndrome. The diagnosis of cardiac hydatid cyst might be difficult on account of varying clinical presentations and nonspesific symptoms. A 75-year-old female was admitted to our hospital with typical chest pain. The patient had no history of previous cardiac symptoms or any illness leading to heart disease. Her ECG revealed ischemic changes. However, her coronary angiography revealed noncritical plaques in the left anterior descending artery. The diagnosis of cardiac echinococcosis was identified using echocardiography, computed tomography and magnetic resonance imaging. The patient was referred to cardiac surgery for resection of the cyst; however, she refused surgery. Albendezol 800 mg/day was prescribed.

Platelet count and mean platelet volume in patients with in-hospital deep venous thrombosis.

AIM: To investigate the relationship between mean platelet volume (MPV) and in-hospital deep venous thrombosis (DVT). MATERIAL AND METHODS: 147 patients with the diagnosis of DVT and 149 control participants were included in the study. For all participants, clinical risk factors, smoking status, and other demographic data were recorded from hospital registries. The data of patients with DVT were compared with the control participants. RESULTS: Mean MPV was significantly higher in patients with DVT than the control group (8.91 ± 1.86 vs 7.86 ± 0.9; P < .001). Body mass index, smoking frequency, hematocrit, and platelet count were significantly correlated with MPV. Independent predictors of in-hospital DVT were MPV (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2-1.87; P ≤ .001), body mass index (OR = 1.17; 95% CI = 1.04-1.34; P = .012), and smoking (OR = 1.83; 95% CI = 1.09-3.08; P = .023). CONCLUSION: Mean platelet volume was significantly higher in patients with DVT, and it is an independent predictor of in-hospital DVT.

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography.

UNLABELLED: Pulmonary Veins are one of the major structures of circulation. In the last decade, pulmonary veins have been known to play an important role as the triggering focus of the electrical activity in atrial fibrillation. Primary treatment method of AF is RF ablation of the focus. For the best ablation, the anatomy of PVs should be well established before the procedure. MATERIAL AND METHODS: In our radiology department, 783 patients underwent computed tomography angiography between January 2008 and May 2010. Patients were referred for coronary CTA because of known or suspected coronary artery disease or computed tomography pulmonary angiography (CTPA) because of known or suspect pulmonary embolism. All scanning was performed on Philips Brilliance 64 slice Multidetector CT. The group consisted of 402 male and 381 female patients with the average age of 48 (range 14-89). CT data of patients were retrospectively reviewed to identify the PV anatomy and to determine anatomic variants and anomalies. RESULTS: In the majority of cases, two pulmonary veins drain into the left atrium on each side. Eighteen and eight variations were found in the right and left sides, respectively. Most frequent combined variations were 2R-4L (32.3%) and 4L was the more frequent single variation type (76%). In addition to that one Situs inversus totalis (0.12%), two partial anomalous pulmonary venous returns (0.25%) and one scimitar syndrome (0.12%) were found. CONCLUSION: This study showed that multiple types of variations of PVs can be found with increasing patient number. Therefore, for the successful ablation and surgery without any complications, the anatomy of PVs should be known before the procedure. MDCT is a reliable imaging method for the detailed cross-sectional and 3D anatomy.

Factors associated with prolonged prehospital delay in patients with acute myocardial infarction.

OBJECTIVES: We investigated factors associated with prolonged prehospital delay in patients with acute myocardial infarction (AMI). STUDY DESIGN: A total of 439 patients (351 males, 88 females; mean age 57+/-12 years) with ST-elevation AMI were interviewed within 48 hours of hospitalization. Patients were pain-free and hemodynamically stable at the time of interview. Data were collected on the time from the onset of chest pain to hospital admission and on sociodemographic and clinical characteristics. The patients were evaluated in two groups according to the place to which the first presentation was made, i.e., a local clinic/small hospital (clinic group: n=209, 47.6%) or our tertiary fully equipped cardiovascular center (hospital group: n=230, 52.4%). RESULTS: The median and mean delay times were 70 min and 185.2+/-334.8 min, respectively. Of the study group, 136 patients (31%) arrived within 60 minutes after the onset of symptoms. The median delay time was significantly longer in the clinic group (120 min vs 60 min; p<0.001). Female sex, age > or = 55 years, and total education time <9 years were associated with a longer prehospital delay, whereas a history of coronary artery disease (CAD), smoking, and the absence of diabetes were associated with a shorter prehospital delay. In multivariate regression analysis, total education time <9 years, female sex, age > or = 55 years, and the absence of previous CAD were independent predictors of prolonged prehospital delay. The incidence of direct hospital presentation significantly increased with older age, smoking, aspirin use, and previous CAD. In multivariate analysis, only previous CAD was an independent predictor of direct hospital presentation. CONCLUSION: The median delay time of 70 min in this Turkish cohort is in accordance with the data from western populations. Public education campaigns to shorten prehospital delay should place more emphasis on the factors and patient subgroups associated with prolonged prehospital delay.