Assessment of Arterial Stiffness with Cardio-Ankle Vascular Index in Patients with Mitral Annular Calcification.

OBJECTIVE: Arterial stiffness is related to arteriolosclerotic diseases and is a marker of adverse cardiovascular events. Mitral annular calcification (MAC) is progressive calcium deposition on the posterior and inferior mitral annulus and is associated with atherosclerotic cardiovascular diseases. Cardio-ankle vascular index (CAVI) is a measurement technique used to estimate the degree of arterial stiffness without effect from blood pressure. The aim of this study is to research arterial stiffness using CAVI in patients with MAC. MATERIALS AND METHODS: The study was cross-sectional and observational and included 98 patients with MAC confirmed by echocardiography who referred to the cardiology clinics and met study inclusion criteria and 38 controls without MAC. CAVI measurements were obtained by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. RESULTS: The two groups were similar in terms of demographic characteristics, including age, sex, hypertension, coronary artery disease, body surface area, and smoking (P > .05). Left atrial volume index was significantly higher in patients with MAC compared with the control group (P < .001). Right arm CAVI, left arm CAVI, and mean CAVI were significantly higher in the MAC group than the control group (P = .037, P = .005, and P = .014, respectively) and increased with MAC severity. There was a significant positive correlation between mean CAVI and MAC grade (r = 0.278, P = .001). Also, when ankle-brachial index (ABI) was measured with CAVI, left and right extremity ABI values were significantly lower in patients with MAC (P = .017 and P = .005, respectively). CONCLUSION: CAVI increased in all patients with MAC and associated with increasing grade of calcification.

Assessment of cardiac mechanics and biomarkers during headache attack in migraine patients with aura: a prospective study.

Migraine with aura (MA) was found to be associated with increased cardiovascular events (CVE), whereas left ventricular (LV) mechanics were not previously studied in migraineurs. In this study, we aimed to assess LV functions with the utility of two-dimensional speckle tracking echocardiography (2D-STE) and cardiac biomarkers with respect to the headache-free and attack periods and frequency of migraine attacks. Sixty-eight patients with MA were enrolled. During headache-free and attack periods, all patients underwent echocardiographic examination including 2D-STE, and cardiac biomarkers, B-type natriuretic peptide (BNP) and high sensitive cTnT (hs-cTnT) were studied. The impact of headache periods and frequency of attacks on cardiac mechanics and biomarkers were investigated. The mean age of study population was 38.1 ± 7.7 years (56 female) and thirty-one patients (44.6%) had high-frequency migraine attacks. Patients who suffered headache-attack periods had higher frequency of detectable hs-cTnT levels and increased NT-proBNP values which did not differ between low- and high-frequency migraine groups in both periods. Headache attack periods had decreased global longitudinal strain (GLS), increased LV end-systolic volume (LVESV), E/Em ratio and LV torsion (LV-tor) during headache-attack periods. In multivariate analysis; LVESV, LV-tor and high frequency of migraine attacks were associated with decreased GLS (≤ - 20.8), (p 0.038, p 0.026 and p 0.013, respectively). Consequently, 2D-STE findings revealed that migraine attacks, especially with increasing frequencies, could have negative impact on LV mechanics, which adds a new perspective about increased CVE in subjects with MA.

Assessment of arterial stiffness in patients with venous thromboembolism: Separate or continuous circuits?

Objectives The aim of this study is to evaluate the association of venous thromboembolism with arterial stiffness by cardio-ankle vascular index method. Method We included 52 patients with a documented lower extremity venous thromboembolism within the last six months and 52 healthy subjects to this cross sectional observational study. Results Cardio-ankle vascular index (8.58 ± 1.60 versus 7.05 ± 1.44, p < 0.001, respectively) and systolic blood pressure (128.02 ± 7.13 mmHg versus 123.94 ± 8.12 mmHg, p = 0.008, respectively) were significantly higher among patients with venous thromboembolism than controls. Cardio-ankle vascular index was an independent predictor of venous thromboembolism in multivariate logistic regression analysis (p < 0.001, odds ratio = 1.864, 95% confidence interval = 1.370-2.536). Cardio-ankle vascular index value > 7.8 had a sensitivity of 82.7% and a specificity of 80.8% for predicting venous thromboembolism (area under curve = 0.789, 95% confidence interval = 0.698-0.863, p < 0.001) in receiver operating characteristic curve analysis. Conclusion We found that arterial stiffness was increased in patients with venous thromboembolism which highlights the fact that arterial and venous circulation is in continuum and an insult may affect both of these circuits.

Assessment of arterial stiffness in patients with chronic lower extremity venous disease: An observational study.

OBJECTIVES: Arterial stiffness is associated with major adverse cardiovascular events. Chronic venous insufficiency (CVI) is severe form of chronic venous disease (CVD). The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with CVI. METHODS: This observational and cross-sectional study involved 87 subjects with CVI and 86 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. RESULTS: High density lipoprotein cholesterol (HDL) was significantly lower in patients with CVI than controls (46.83 ± 9.25 mg/dl vs 51.33 ± 11.13 mg/dl, p = 0.004). Body mass index (BMI) was significantly higher in CVI patients than controls (28.53 ± 4.10 kg/m(2) vs 26.37 ± 5.16 kg/m(2), p = 0.003). Ankle brachial index (ABI) was significantly lower in patients with CVI compared to controls (1.08 ± 0.08 vs 1.14 ± 0.11, p < 0.001). CAVI was significantly higher in patients with CVI than controls (7.94 ± 1.37 vs 6.73 ± 1.16, p < 0.001). Mean arterial pressure (MAP) was significantly higher in patients with CVI than control group (105.41 ± 10.77 mmHg vs 99.70 ± 11.17 mmHg, p = 0.001). CAVI (p < 0.001, Odds ratio (OR) = 2.033, 95% Confidence interval (CI) = 1.493-2.768), ABI (p = 0.003, OR = 0.003, 95% CI = 0.001-0.137), female sex (p < 0.001, OR = 3.949, 95% CI = 1.613-9.663), and HDL (p < 0.001, OR = 0.923, 95% CI = 0.883-0.964) were the independent predictors of CVI. A CAVI value > 7.9 had a sensitivity 64.4% and a specificity of 94.7% for predicting the presence of CVI in ROC analysis (area under curve = 0.791, 95% CI = 0.723-0.849, p < 0.001). CONCLUSION: CAVI is independently increased in CVI patients. Therefore CVI may be accepted a form of vascular sclerosis and vascular system should be evaluated in continuum not isolated.

Assessment of Left Atrial Mechanics in Patients with Preexcitation Syndrome Scheduled for Catheter Ablation.

OBJECTIVES: We aimed to test the left atrial (LA) mechanics and contraction synchrony by 2D strain imaging, in patients with Wolff-Parkinson-White (WPW) syndrome, before and after radiofrequency catheter ablation (RFCA). METHODS: Study population consisted of 25 patients with WPW scheduled for RFCA and 30 healthy controls. The peak LA strain at the end of the ventricular systole (LAs strain) and the LA strain with LA contraction (LAa Strain) were obtained. To assess LA dyssynchrony, septal versus lateral wall time-to-peak strain measurements were measured. RESULTS: There was no difference between the patients with WPW and control subjects with regard to peak LAs and LAa strain. Patients with WPW demonstrated higher global time-to-peak LAs and LAa strain values compared with the control group. Peak LAs strain and LAa strain values, measured before and after the RF ablation of the accessory pathway, were comparable (34.3 ± 3.92 vs. 34.6 ± 3.2, P = 0.816, 14.7 ± 2.8 vs. 15.3 ± 2.3, P = 0.052, respectively). Global time-to-peak LAs and LAa strain measurements were significantly shorter after the RFCA compared with the values obtained before the RFCA. However, septo-lateral times to peak LA strain differences were found to be comparable in both WPW versus control and pre- versus postablation groups. CONCLUSION: LA mechanical function assessed by 2D strain imaging was comparable between patients with WPW and control subjects. Patients with WPW had more prominent LA dyssynchrony during atrial pump phase as compared with the controls, a condition which could not improve after successful elimination of the accessory pathway by RFCA.

Assessment of Silent Neuronal Injury Following Coronary Angiography and Intervention in Patients With Acute Coronary Syndrome.

The aim of this study is to evaluate the incidence and predictors of silent neuronal injury (SNI) after coronary angiography (CAG) and intervention by serial measurement of serum neuron-specific enolase (NSE) in patients presented with acute coronary syndrome (ACS). Ninety-eight consecutive patients presented with ACS and underwent CAG and intervention were included in the study. The NSE levels significantly increased after CAG and intervention compared to baseline levels (22.03 ± 27.70 and 10.08 ± 3.15 consecutively). Left ventricular ejection fraction in the SNI+ group was significantly lower than that in the SNI- group (43.71% ± 12.51%, 50.84% ± 9.34%, P = .002). Maximal creatinine kinase myocardial band, troponin I, and SYNTAX score of the SNI+ group were significantly higher than those of the SNI- group (103.83 ± 99.22, 51.92 ± 78.33, P = .006; 50.04 ± 66.18, 19.18 ± 30.50, P = .002; 103.83 ± 99.22, 51.92 ± 78.33, P = .006; and 50.04 ± 66.18, 19.18 ± 30.50, P = .002 successively). SYNTAX score and performing percutaneous coronary intervention were the independent predictors of SNI (P = .009, odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.014-1.107, P = .036, OR = 4.262, 95% CI = 1.097-16.56). Percutaneous coronary intervention and coronary artery lesion complexity may increase the risk of SNI in patients with ACS.

Assessment of vascular dysfunction after transradial coronary angiography. Is a single catheter better?

BACKGROUND: The aim of this study was to investigate the midterm effects of transradial coronary angiography (TRCAG) on the radial and brachial artery diameter, the vasodilator characteristics, as well as to assess the factors determining functional recovery. METHODS: This study included 136 consecutive patients who underwent TRCAG. The radial artery was evaluated with ultrasonography before and 1 month after the procedure. RESULTS: The basal right radial artery diameter (2.97 ± 0.46 vs. 2.82 ± 0.51, p < 0.001), after flow-mediated dilatation (FMD; 3.18 ± 0.45 vs. 2.99 ± 0.54, p < 0.001) and after nitroglycerin-mediated dilatation (NMD; 3.32 ± 0.45 vs. 3.11 ± 0.54, p < 0.001), and the percentage change in diameter after FMD (7.50 ± 3.62 vs. 5.89 ± 3.04, p < 0.001) and NMD (12.42 ± 4.96 vs. 10.54 ± 4.47, p < 0.001) were significantly decreased 1 month after TRCAG. The mean basal diameter of the right brachial artery (4.41 ± 0.58 vs. 4.40 ± 0.58, p = 0.012) after FMD (4.61 ± 0.60 vs. 4.59 ± 0.59, p < 0.001) and the percentage change in diameter after FMD (4.53 ± 2.29 vs. 4.33 ± 2.56, p = 0.038) were significantly decreased 1 month after TRCAG. The number of catheters used (B = 0.372, p < 0.001, 95 % CI = 0.006-0.013), basal radial artery diameter (B = - 0.217, p = 0.001, 95 % CI = - 0.021- 0.006), presence of hypertension (B = - 0.151, p = 0.011, 95 % CI = - 0.015 - 0.002), and pain score (B = 0.493, p < 0.001, 95 % CI = 0.007 - 0.012) were independent predictors of radial artery FMD change in multivariate regression analysis. The number of catheters used (B = 0.378, p < 0.001, 95 % CI = 0.009 - 0.020), basal radial artery diameter (B = - 0.210, p = 0.010, 95 % CI = - 0.034 - 0.005), and pain score (B = 0.221, p < 0.001, 95 % CI = 0.002-0.011) were independent predictors of radial artery NMD change in multivariate regression analysis. CONCLUSION: Basal radial artery diameter, the number of catheters used during TRCAG, and the pain perceived during the procedure seem to be important predictors of vascular functional changes after TRCAG.

Value of serum fibrinogen levels in the assessment of mechanical prosthetic valve thrombosis.

BACKGROUND AND AIM OF THE STUDY: The evaluation of prosthetic valve thrombosis (PVT) is crucial due to higher mortality and morbidity rates. The study aim was to assess the value of fibrinogen in the diagnosis of PVT, an important and a common cause of prosthetic valve failure. METHODS: Between December 2007 and April 2012, 154 patients with PVT and 116 control subjects with a normally functioning prosthesis were enrolled in the study. PVT was diagnosed using transesophageal echocardiography, and fibrinogen levels were measured at presentation. The patients and controls had similar demographic features. RESULTS: NYHA functional class, ineffective anticoagulation, presence of symptoms and moderate to severe left atrial spontaneous echo contrast (LASEC) were significantly different between the groups. The fibrinogen level was significantly higher in patients with PVT compared to controls (393.46 +/- 127.87 versus 276.93 +/- 69.22 mg/dl, p < 0.001). Ineffective anticoagulation, the presence of symptoms, a poor NYHA functional class, the presence of moderate to severe LASEC and elevated fibrinogen levels were independent predictors of PVT on multivariate regression analysis (p < 0.001, odds ratio (OR) 38.811, 95% confidence interval (CI): 13.319-113.091; p < 0.001, OR 6.745, CI: 2.777-16.386; p = 0.031, OR 3.557, CI: 1.126-11.239; p = 0.026, OR 3.203, CI: 1.146-8.955, and p < 0.001, OR 1.011, CI: 1.007-1.016 respectively). CONCLUSION: Besides known indicators of PVT, including ineffective anticoagulation, the presence of LASEC and decreased NYHA functional capacity, elevated fibrinogen levels may be a valuable marker for the assessment of PVT.

Assessment of cardio-ankle vascular index in patients with cardiac syndrome-X: an observational study.

OBJECTIVE: Arterial stiffness is associated with major adverse cardiovascular events. Cardio-ankle vascular index (CAVI), a novel marker of arterial stiffness, which is weakly influenced by systolic blood pressure, is a sensitive marker the atherosclerosis and arteriolosclerosis. The aim of this study is to investigate arterial stiffness by CAVI in patients with cardiac syndrome X (CSX). METHODS: The present study was observational and cross sectional, and involved 49 patients (26 male) with CSX (angina-like chest pain, positive electrocardiographic ischemic changes at treadmill exercise test, angiographically normal coronary arteries) and 54 healthy subjects (21 male). CAVI was measured by VaSera-1000 CAVI instrument. Statistical analysis was performed using the Chi-square, Student t-test, correlation analysis and logistic regression analysis. RESULTS: The CAVI and pulse pressure were significantly increased in patients with CSX compared to control group (7.50 ± 1.50, 6.49 ± 0.77, p<0.001; 53.00 ± 10.06, 47.39 ± 8.17, p=0.002, consecutively). In contrast, there were no significant differences in the age, weight, height, body mass index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure, mean blood pressure, glucose, low density lipoprotein level, high density lipoprotein level, triglyceride, estimated creatinine clearance, hemoglobin, left atrium diameter, left ventricular mass, LVM index and ejection fraction. CAVI was the only independent predictor of CSX in logistic regression analysis (OR=1.780, 95% CI: 1.157-2.737, p=0.009). CONCLUSION: CAVI is increased in syndrome X patients and is an independent predictor of this syndrome.

A new hope in the treatment of coronary vasospasm: bosentan.

Atherosclerosis is the most important cause of acute coronary syndromes. The mediators that trigger vasospasm, including endothelin and serotonin, are synthesized and secreted into circulation from atherosclerotic plaques and surrounding tissues. A 68-year-old man was hospitalized due to acute coronary syndrome four times in a one-year period. The patient presented to emergency service again with heartburn and a pressure-like pain in his upper abdomen in February 2012. He was admitted to the coronary care unit with the detection of a more than three-fold increase in troponin values and ischemic changes on electrocardiography. By decision of the cardiology council, the endothelin receptor antagonist, bosentan was added to the treatment. There were no contraindications to this medication according to his blood and hepatic indicators. After confirmation of the Social Security Institution, bosentan was started as 62.5 mg twice a day. After the first month, the dose was increased to 125 mg b.i.d. As of completion of the eighth month of treatment with bosentan, the patient had not been hospitalized due to angina attack or acute coronary syndrome.

The value of real-time three-dimensional transesophageal echocardiography in the assessment of paravalvular leak origin following prosthetic mitral valve replacement.

OBJECTIVES: Two-dimensional (2D) echocardiographic approaches are not sufficient to determine the origin of paravalvular leak (PVL) that occurs after prosthetic mitral valve replacement (MVR). In this study, we investigated the role of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in detecting the origin and size of PVL occurring after prosthetic MVR. STUDY DESIGN: The study included 13 patients (7 females; 6 males; mean age 56+/-10 years; range 37 to 71 years) who developed PVL within a mean of 8.3+/-3.8 years following mechanical prosthetic MVR. Nine patients (69.2%) had atrial fibrillation, and four patients (30.8%) had normal sinus rhythm. Four patients (30.8%) had hemolysis. Paravalvular leak was mild, moderate, and severe in two, six, and five patients, respectively. Real-time 3D TEE was performed using a 3D matrix-array TEE transducer immediately after detection of PVL on 2D TEE examination. Localization of PVL was made using a clock-wise format in relation to the aortic valve and the size of dehiscence was measured. RESULTS: The mean PVL width measured by 2D TEE was 3.00+/-0.92 mm. The mean length of dehiscence was 13.6+/-8.8 mm, and the mean width was 3.88+/-2.04 mm on RT-3D TEE. The PVLs were mainly localized in the posterior and anterior annular positions between 12 to 03 hours (n=7) and 06 to 09 hours (n=3) on RT-3D TEE, respectively, which corresponded to the posteromedial or anterolateral sectors of the posterior annulus. CONCLUSION: Considering that only the width of the PVL defect can be assessed by 2D TEE, delineation by RT-3D TEE includes the localization of PVL together with the length and width of the defect.