Effectiveness of Handmade "Jacky-Like Catheter" As a Single Multipurpose Catheter in Transradial Coronary Angiography: A Randomized Comparison With Conventional Two-Catheter Strategy.

OBJECTIVE: To investigate safety and efficacy of specialized hand-modified "Jacky-Like" catheter (JLC) as a single dual-purpose catheter in transradial coronary angiography. METHODS: Patients over 18 years undergoing diagnostic CAG through right radial artery (RRA) were prospectively enrolled. Procedures were performed with a single JLC modified from a left Judkins (JL) 3.5 catheter or by using 2-catheter approach (2C). Procedures with coronary artery bypass grafts or ventricular angiographies were excluded from the study. Three hundred and eighty-seven transradial procedures were performed successfully. One hundred and ninety-four procedures were performed with 2C and 193 procedures with a JLC. Inability to use intended catheters, total fluoroscopic time in minutes, the consumption of contrast medium in milliliter, development of radial artery spasm (RAS), and radial artery occlusion (RAO) were evaluated. RESULTS: In the 2C group, angiography was successfully performed on the RCA of 191 patients (98.9%) and on LCA in 192 patients (99.4%). In the JLC group, angiography was successfully performed on the RCA and LCA of 193 (99.4%) and 174 (89.6%) patients, respectively. Utilization of supplemental catheters was significantly greater in the JLC group (21; 10.8%) versus the 2C group (3; 1.5% P = 0.001). Mean fluoroscopy time was shorter in the JLC group (2.0 ± 2.3 min vs. 2.3 ± 1.5 min; P = 0.043). Mean procedure time was also decreased with JLC but did not reach statistical significance (5.7 ± 3.1 min vs. 6.2 ± 2.5 min; P = 0.081). When additional time for reshaping the JLC was not taken into account, mean procedure time was significantly decreased in the JLC group (5.6 ± 2.9 min vs. 6.2 ± 2.4 min; P = 0.031). There was a trend toward lower incidence of consumption of contrast medium in the 2C group (49 ± 13 mL vs. 52 ± 18 mL; P = 0.061). RAS was observed more frequently in the 2C group (11.3% vs. 21.7%, P = 0.005). There was a trend toward high incidence of RAO in the 2C group (4.1 vs. 8.3% P = 0.064). CONCLUSION: In transradial procedures from RRA, a JLC catheter can be very effective when dedicated dual-purpose catheter is not available.

Effectiveness of Left Judkins Catheter as a Single Multipurpose Catheter in Transradial Coronary Angiography From Right Radial Artery: A Randomized Comparison With Conventional Two-Catheter Strategy.

OBJECTIVES: To investigate safety and efficacy of left Judkins (JL) catheter as a single multipurpose catheter in transradial coronary angiography (TRA). BACKGROUND: Most operators use standard femoral catheters instead of special multipurpose transradial catheters during TRA. METHODS: Patients undergoing TRA through right radial artery (RRA) were randomized into single-catheter approach with JL3.5 and two-catheter approach with JL3.5 and right Judkins 4.0 catheters. Primary outcome measures were rate of success in selective and stable engagement of both coronary arteries with JL catheter, procedure and fluoroscopy times. RESULTS: Of 314 patients enrolled, 206 patients (aged 60.3 ± 12.4 years, 36.9% female) were randomized. JL3.5 was successful in 66.0% of patients as a single catheter. Additional catheter was needed more frequently in single-catheter group (34 vs. 0.97%, P < 0.001). Single-catheter approach reduced procedure time significantly (6.7 ± 2.1 vs. 7.9 ± 3.3 minutes, P = 0.002). However on average there was 19.7% relative increase in fluoroscopy time (2.61 ± 1.38 vs. 2.18 ± 1.54 minutes, P = 0.035) with single-catheter approach. Radial artery spasm tended to develop more frequently in two-catheter group (22.3 vs. 12.6%, P = 0.067). In nearly half of the patients, procedure had been completed successfully with JL3.5 catheter within a fluoroscopy time similar to that of two-catheter group. CONCLUSION: In TRA from RRA, JL3.5 catheter can be very effective when dedicated multipurpose catheter is not available. As a single multipurpose catheter, JL works perfectly in nearly half of procedures without prolonging procedure and fluoroscopy times. However insisting on a single-catheter approach with JL could unnecessarily increase fluoroscopy time and, hence, radiation exposure. (J Interven Cardiol 2016;29:257-264).

Simplified Cardioneuroablation in the Treatment of Reflex Syncope, Functional AV Block, and Sinus Node Dysfunction.

BACKGROUND: Cardio neuroablation (CNA) is a lesser-known technique for management of patients with excessive vagal activation on the basis of radiofrequency catheter ablation (RFCA) of the areas related to the three main autonomic ganglia around the heart. We investigated the effectiveness of selective and/or stepwise RFCA of these areas via right atrium (RA) and/or left atrium (LA) in the patients with recurrent syncope due to excessive vagal activity. METHODS: Twenty-two patients presenting symptomatic functional bradyarrhythmias, neurally mediated reflex syncope (NMS), symptomatic atrioventricular (AV) block, and symptomatic sinus node dysfunction (SND; number = 8, 7, 7, respectively) were enrolled. The three main paracardiac ganglia were targeted via RA and LA in the patients with NMS and SND. The procedure was performed via RA in the patients with AV block, followed by RFCA of all ganglia via LA, if AV conduction disorder persists. The sites showing fragmented potentials were identified by electrical mapping and verified by high-frequency stimulation and ablated until atrial electrical potential was completely eliminated (<0.1 mV). RESULTS: The patients with NMS and SND were free from new syncopal episode at a mean 12.3 ± 3.4 months and 9.5 ± 3.1 months follow-up, respectively. Ablation from RA was successful in six of seven patients with AV block. Despite the increased heart rate, the resolution of AV block after the RFCA could not be achieved in one patient who had partial resolution with atropine infusion on admission. CONCLUSION: CNA may be an alternative and safe strategy to reduce NMS episodes, and to treat functional AV block and symptomatic SND, especially in young patients.

A challenging case of transvenous lead extraction.

A 72-year-old male patient with a 7-year history of cardioverter-defibrillator (ICD) implantation was admitted to our clinic with pocket infection. One year prior to this admission, he had undergone an unsuccessful extraction procedure at another clinic, during which the older broken ICD lead had been left in place and a newer ICD lead implanted via the same pocket. The newer and older leads were extracted by mechanical dilator sheath and needle eye snare respectively.

Assessment of subtle cardiac dysfunction induced by premature ventricular contraction using two-dimensional strain echocardiography and the effects of successful ablation.

INTRODUCTION AND OBJECTIVES: We aimed to assess the effects of successful ablation on impaired left ventricular global longitudinal strain (LV-GLS) in patients with frequent premature ventricular contractions (PVCs). We also evaluated the potential risk factors of impaired LV-GLS. METHODS: Thirty-six consecutive patients without any structural heart disease, who were treated with radiofrequency (RF) ablation due to frequent PVCs, were included in the study. All patients were evaluated with standard transthoracic and two-dimensional speckle tracking echocardiography. RESULTS: Mean LV-GLS before ablation was 17.3±3.7 and 20.5±2.6 after ablation; the difference was statistically significant (p<0.01). Patients were categorized into two groups: those with LV-GLS value >-16% and those ≤16%. Low PVC E flow/post-PVC E flow and PVC SV/post-PVC SV ratios were associated with impaired LV-GLS. CONCLUSION: In symptomatic patients with frequent PVCs and normal left ventricular ejection fraction, we observed significant improvement in LV-GLS value following successful RF ablation. Patients with impaired LV-GLS more often display non-ejecting PVCs and post-extrasystolic potentiation (PEP) compared to patients with normal LV-GLS.

The impact of automatic history-taking software on data quality in the cardiology outpatient clinic: Retrospective observational study.

Background: Healthcare delivery now mandates shorter visits despite the need for more data entry, under-mining patient-provider interaction. Furthermore, enhancing access to the outcomes of prior tests and imaging conducted on the patient, along with accurately documenting medication history, will significantly elevate the quality of healthcare service delivery. Objective: To enhance the efficiency of clinic visits, we have devised a patient-provider portal that systematically gathers symptom and clinical data from patients through a computer algorithm known as Automated Assessment of Cardiovascular Examination (AACE). We intended to assess the quality of computer-generated Electronic Health Records (EHRs) with those documented by physicians. Methods: We conducted a cross-sectional study employing a paired-sample design, focusing on individuals seeking assessment for active cardiovascular symptoms at outpatient adult cardiovascular clinics. Participants initially completed the AACE, and subsequently, in the first protocol, patients were subjected to routine care without providing the AACE forms to examining physicians. In the second protocol, the AACE form was presented to the physician before the examination, and participants were subjected to routine care. We assessed the impact of AACE forms generated through computerized history-taking method on the examination, considering various clinical outcomes and satisfaction surveys. Results: We included non-randomized eligible patients who visited seven general cardiology outpatient clinics between September 18, 2023, and October 27, 2023. These clinics were staffed by the same physicians who were unaware of the content and details of the study. A total of 762 patients (394 patients in protocol 1 and 368 patients in protocol 2) were included in the study. The mean overall impression score for computer-generated EHRs was higher versus physician EHRs (4.2 vs. 2.6; p < .001). Our study demonstrated that EHRs created by physicians' exhibit inaccuracies or deficiencies in various pieces of information. In the second protocol, in which the AACE form was presented to the physician before the examination, it was determined that the examination time was shorter, the number of tests requested, and the number of new drugs prescribed were less. Conclusions: We observed that the patient-provider portal, systematically collecting symptom and clinical data from patients through a computer algorithm known as AACE, yielded records that were of higher quality, more comprehensive, better organized, and more relevant compared to those documented by physicians.

Evaluation of the relationship between monocyte to high-density lipoprotein cholesterol ratio and thrombus burden in patients with deep vein thrombosis.

OBJECTIVE: The purpose of this study was to evaluate monocyte count and high-density lipoprotein cholesterol levels and their ratio (monocyte/high-density lipoprotein ratio) in patients with deep venous thrombosis as well as to determine whether this ratio at the time of diagnosis can be an indicator of thrombus burden in terms of thrombus location in deep venous thrombosis. METHODS: We retrospectively analyzed the patient's diagnosis of deep venous thrombosis confirmed with venous Doppler ultrasound, using a database query for outpatients between 2018 and 2022. Of 378 patients included, blood count results at the time of diagnosis were available for 356. We recruited 300 age- and sex-matched patients with appropriate blood counts, without a diagnosis of deep venous thrombosis, as the control group, by querying the outpatient clinic database. The monocyte/high-density lipoprotein ratio was computed from the ratio of monocyte count to high-density lipoprotein-C. Patients were categorized based on the level of thrombus and the number of vein segments involved as evidenced by Doppler ultrasound findings. RESULTS: The serum level of monocyte/high-density lipoprotein ratio was significantly higher in the patient group compared to the control group (p<0.01). Patients with proximal deep venous thrombosis had a higher mean monocyte/high-density lipoprotein ratio (19.6±5.1 vs. 17.1±5.5; p<0.01) than patients with distal deep venous thrombosis. Monocyte/high-density lipoprotein ratio increased with the number of vein segments involved (p<0.01). CONCLUSION: Monocyte/high-density lipoprotein ratio is significantly elevated in patients with deep venous thrombosis when compared to the control group. Monocyte/high-density lipoprotein ratio levels were correlated with disease burden reflected by thrombus location and the number of vein segments involved in deep venous thrombosis patients.

Association Between History of Polymerase Chain Reaction-verified COVID-19 Infection and Outcomes of Subsequent ST-Elevation Myocardial Infarction.

While the acute phase of coronavirus disease 2019 (COVID-19) is associated with worsening cardiac outcomes, it is unclear whether it affects the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after the acute phase. In addition, while many studies compared the course of STEMI during the COVID-19 pandemic with the years before the outbreak, we evaluated the course of STEMI during the pandemic according to whether or not patients had history of COVID-19. Patients diagnosed with STEMI during the ongoing COVID-19 pandemic were included in the study. The Ministry of Health database was analyzed retrospectively, and patients with (n = 191) and without (n = 127) a history of polymerase chain reaction (PCR) confirmed COVID-19 infection were divided into groups. Clinical and angiographic characteristics were assessed. The rates of in-hospital major adverse cardiac events (MACE) were higher in those who had a history of PCR-verified COVID-19 infection. Angiographic and procedural findings indicating successful reperfusion were better in patients without a history of COVID-19. A history of COVID-19 infection (odds ratio 1.40, 95% confidence interval 1.25-1.60, P < .01) independently predicted MACE. A history of COVID-19 infection is a predictor of worse outcomes following coronary intervention and in-hospital MACE among patients with STEMI.

The protective effect of erdosteine on radiocontrast induced nephrotoxicity in rats.

Acute renal failure resulting from radiocontrast-induced nephrotoxicity (RIN) is suggested to occur via medullary ischemia coupled with the generation of free radicals and oxidative injury to tubular cells. The aim of the present study was to assess the effects of erdosteine on prevention of RIN. Thirty-three Wistar-albino rats were divided into five groups: control (group 1, n = 6), radiocontrast media (group 2, n = 6), erdosteine (group 3, n = 7), erdosteine four doses before radiocontrast application (group 4, n = 7) and erdosteine one dose at the same day with radiocontrast application (group 5, n = 7). RIN was induced by administration of intravenous high osmolar contrast media amidotrizoate (6 mL/kg). Total RNA was extracted from the kidney, and the expression levels of Lipocalin 2 (Lcn2) and secreted phosphoprotein 1 (Spp1) genes were evaluated by real time reverse transcription polymerase chain reaction (real-time RT-PCR). Total antioxidant status (TAS) and total oxidant status (TOS) were measured in kidney homogenates and serum samples. Serum creatinine, BUN (Blood Urea Nitrogen) and cystatin-C levels were measured from serum samples. The kidneys were evaluated histopathologically. The expression levels of Spp1 and Lcn2 genes in group 2 were significantly higher than groups 1, 3, 4, and 5. The expression levels of Spp1 and Lcn2 genes in group 4 were four and two times lower than group 5, respectively. Kidney TOS levels in group 2 were significantly higher than groups 1, 3, 4, and 5. Kidney TAS levels in group 3 were higher than group 2. Kidney oxidative stress index (OSI) levels in group 2 were significantly higher than groups 4 and 5. All rats in contrast media group developed tubular necrosis, proteinaceous casts, medullary congestion although these changes were significantly reduced in groups 4 and 5. This study demonstrated that multiple doses of erdosteine before application may have higher protective effects against RIN.

The prognostic value of mean platelet volume in decompensated heart failure.

BACKGROUND: Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. AIM: To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). METHODS: 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18±12 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. RESULTS: MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18±12 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p=0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p=0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p<0.001), respectively). CONCLUSION: MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.

Mean platelet volume in patients with dipper and non-dipper hypertension.

Patients with non-dipper hypertension are known to carry a high risk of cardiovascular complications. In this study, we hypothesized that non-dippers may be associated with platelet dysfunction and it can be determined by mean platelet volume (MPV). A total of 216 outpatients treated with antihypertensive drugs for at least 6 months were enrolled. Dipper and non-dipper patterns were detected and clinical, laboratory and ambulatory blood pressure recording data were matched between non-dipping and dipping groups. MPV was significantly higher in patients in non-dipping than dipping groups (p<0.001). In correlation analyses, MPV was negatively correlated with the rate of systolic and diastolic fall at night (p<0.001, r=-0.46) and (p<0.001, r=-0.43), respectively. Also MPV was correlated with nocturnal pulse pressure (p=0.001, r=0.22). Other variables were similar between non-dipping and dipping groups. The present study showed that MPV is higher in non-dipping than dipping hypertensive patients. Platelet activation or dysfunction probably is an alternative mechanism for increasing cardiovascular events in non-dippers.

The effect of non-dipper pattern of hypertension on erectile dysfunction.

BACKGROUND: The purpose of this study was to evaluate the relationship between erectile dysfunction (ED) and non-dipper pattern in hypertensive patients. METHODS: A total of 750 consecutive patients with essential hypertension, who had been evaluated with ambulatory BP monitoring, were screened for this study. One hundred and thirty-two male patients (age range 28-54 years) who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and non-dipper patterns were detected and sexual function was assessed by the self-administered questionnaire of the International Index of Erectile Function (IIEF). RESULTS: There was no significant difference between the two groups regarding the number of medications taken and the proportion of each class of antihypertensive medications. Mean age, body mass index, lipid profiles, rate of smoking were similar between the two groups. IIEF score was significantly higher in non-dippers than dippers (p= 0.009). Non-dipping was also found to be an independent determinant for ED. CONCLUSION: The result of the present study further suggests that non-dipping is a risk indicator for early deterioration of erectile function in hypertensive patients.

Syncope caused by hyperkalemia during use of a combined therapy with the angiotensin-converting enzyme inhibitor and spironolactone.

A 76 year-old woman with a history of coronary artery bypass grafting and prior myocardial infarction was transferred to the emergency room with loss of consciousness due to marked bradycardia caused by hyperkalemia. The concentration of serum potassium was high, and normal sinus rhythm was restored after correction of the serum potassium level. The cause of hyperkalemia was considered to be several doses of spiranolactone, an aldosterone antagonist, in addition to the long-term intake of ramipril, an ACE inhibitor. This case is a good example of electrolyte imbalance causing acute life-threatening cardiac events. Clinicians should be alert to the possibility of hyperkalemia, especially in elderly patients using ACE/ARB in combination with potassium sparing agents and who have mild renal disturbance.

A case of acute stent thrombosis treated successfully with intracoronary tirofiban.

Acute stent thrombosis (AST) is occasionally observed during percutaneous coronary intervention in patients with acute coronary syndrome (ACS). It may jeopardize hemodynamic status. Currently, there is no adequate solution for this problem. We report our experience with an ACS patient who developed AST associated with cardiogenic shock after percutaneous coronary stent deployment. Intracoronary administration of tirofiban immediately restored the coronary flow of the target vessel, and the disastrous condition was reversed. Our experience suggests that intracoronary administration of tirofiban can be considered as an option in cases of AST during percutaneous coronary intervention.

The addition of metamizole to morphine and paracetamol improves early postoperative analgesia and patient satisfaction after lumbar disc surgery.

AIM: Combined analgesic regimens produce sufficient analgesia by additive or synergistic effects, and reduce the total dose of analgesics and minimise adverse effects. We investigated the metamizole, paracetamol and morphine combination with respect to postoperative pain treatment in lumbar disc surgery. MATERIAL AND METHODS: After Ethics Committee approval and informed consent, 63 patients were allocated to three treatment groups; as Group paracetamol: paracetamol (1 g), Group paracetamol-metamizole: paracetamol (1 g) and metamizole (1 g), and Group placebo: no analgesic. All the patients received intravenous (i.v.) morphine with a patient-controlled analgesia device (PCA) as the rescue analgesic. Pain was assessed by the numerical pain rating scale (NRS, 0-3). Total morphine consumption at 24 hours, patient satisfaction and side effects were investigated. RESULTS: NRS of Group paracetamol-metamizole was low at 15th min, 30th min and 1st hour, and the difference reached statistical significance at 30th min (p=0.033). Patient satisfaction at the same measurement times was high in this group. Total morphine consumption and side effects were not statistically different between the three groups. CONCLUSION: Addition of metamizole to paracetamol along with iv morphine PCA offers an advantage over single iv morphine PCA and paracetamol, with respect to early postoperative pain treatment and patient satisfaction.

[Myocardial noncompaction recognized following a transient ischemic attack]. / Geçici iskemik atak sonrasi saptanan süngerimsi miyokart (noncompaction).

Myocardial noncompaction is a rare type of congenital cardiomyopathy characterized by excessively prominent trabeculations in one or more segments of the ventricles and deep intertrabecular recesses in ventricular walls. A 25-year-old male patient presented to the neurology department with complaints of weakness in the left extremities. A mild loss of muscle strength was detected on neurological examination. With a preliminary diagnosis of acute cerebrovascular event, treatment with aspirin and enoxaparin was instituted, which improved his complaints within two hours. Electrocardiography showed sinus rhythm, left ventricular hypertrophy, and loss of R-wave progression in the precordial leads. Transthoracic echocardiography showed apical hypokinesia, marked left ventricular hypertrophy, and normal left ventricular diameters. There were numerous trabeculations in the apex, apical, lateral, and inferior walls, and deep intertrabecular recesses. Color Doppler showed blood flow into the intertrabecular recesses. He also had mild mitral regurgitation and diastolic dysfunction of restrictive type. He was scheduled for outpatient follow-up on aspirin and warfarin treatment.

Diastolic Dyssynchrony in Acute ST Segment Elevation Myocardial Infarction and Relationship with Functional Recovery of Left Ventricle.

BACKGROUND: Incidence of diastolic dyssynchrony (DD) and its impact on functional recovery of left ventricle (LV) after ST segment elevation myocardial infarction (STEMI) is not known. METHODS: Consecutive patients with STEMI who underwent successful revascularization were prospectively enrolled. Echocardiography with tissue Doppler imaging was performed within 48 hours of admission and at 6 months. LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), and left atrial volume index (LAVI) were calculated. Diastolic delay was calculated from onset of QRS complex to peak of E wave in tissue Doppler image and presented as maximal temporal difference between peak early diastolic velocity of 6 basal segments of LV (TeDiff). Study patients were compared with demographically matched control group. RESULTS: Forty eight consecutive patients (55 ± 10 years, 88% male) and 24 controls (56 ± 6 years, 88% male) were included. TeDiff was higher in STEMI than in controls (35.9 ± 19.9 ms vs. 26.3 ± 6.8 ms, p = 0.025). Presence of DD was higher in STEMI than controls (58% vs. 33%, p = 0.046) according to calculated cut-off value (≥ 29 ms). There was no correlation between TeDiff and change in EDVI, ESVI, and LAVI at 6 months, however TeDiff and change in EF at 6 months was positively correlated (r = 0.328, p = 0.023). Patients with baseline DD experienced remodeling less frequently compared to patients without baseline DD (11% vs. 38%, p = 0.040) during follow-up. CONCLUSION: STEMI disrupts diastolic synchronicity of LV. However, DD during acute phase of STEMI is associated with better recovery of LV thereafter. This suggests that DD is associated with peri-infarct stunned myocardium that is salvaged with primary intervention as well as infarct size.

Inappropriate combination of warfarin and aspirin.

OBJECTIVE: A combination of warfarin and aspirin is associated with increased bleeding compared with warfarin monotherapy. The aim of the study was to investigate the incidence and appropriateness of the combination of warfarin and aspirin in patients with atrial fibrillation (AF) or mechanical heart valve (MHV). METHODS: This cross-sectional study included consecutive patients with AF or MHV on chronic warfarin therapy (>3 months) without acute coronary syndrome or have not undergone a revascularization procedure in the preceding year. Medical history, concomitant diseases, and treatment data were acquired through patient interviews and from hospital records. RESULTS: Three hundred and sixty patients (213 with AF, 147 with MHV) were included. In those with AF, a significantly higher warfarin-aspirin combination was observed with concomitant vascular disease (38.8% vs. 14.6%), diabetes (36.6% vs. 16.3%), statin therapy (40% vs. 16.9%), left ventricular systolic dysfunction (33.3% vs. 17.5%) (p<0.05 for all). The use of combination therapy was similar between different CHADS-VASc scores. In patients with MHV, higher combination therapy was observed in males (41% vs. 26.7% in females; p=0.070), concomitant vascular disease (47.8% vs. 29.8%; p=0.091), and AF (56.3% vs. 29.8%; p=0.033). Independent predictors of warfarin-aspirin combination were concomitant vascular disease, diabetes, and (younger) age in patients with AF and were concomitant AF and male sex in patients with MHV. Interestingly, the incidence of combination therapy was found to increase with a higher HAS-BLED score in both patients with AF and MHV (p<0.001). CONCLUSION: The combination of warfarin and aspirin was found to be prescribed to patients with AF mainly for the prevention of cardiovascular events, for which warfarin monotherapy usually suffices. On the other hand, co-treatment with aspirin appeared to be underused in patients with MHV.

Incidence and predictors of radial artery injury following transradial procedures: Yet another benefit of renin-angiotensin system blockade?

BACKGROUND: Vasodilatory function of radial artery (RA) declines following the transradial catheterization. However, it is uncertain whether impaired vasodilatory function develops in every patient. The aim of this study was to investigate the incidence and predictive factors of impaired vasodilatory function following transradial procedures. METHODS: Consecutive patients undergoing elective transradial procedures were prospectively enrolled. Ultrasound examination of RA was recorded just before and 1 week after the procedure. RA diameters and flow velocities were measured at baseline, after flow mediated vasodilation (FMD) and after nitrate mediated vasodilation (NMD). RESULTS: Fifty-one patients were included (62 ± 11 years, 55% male, 41% hypertensive, 20% diabetic, 65% with coronary artery disease). Overall FMD and NMD were significantly impaired after 1 week. However, deterioration of FMD and NMD was observed in 67% and 71% of patients, respectively. Absolute change in FMD was significantly different in patients using a renin- angiotensin system (RAS) inhibitor compared to those who were not (1.9 ± 12.9 vs. -7.7 ± ± 12.7%, respectively, p = 0.025). Additionally, there was a moderate but significant correlation between baseline RA diameter and absolute change in NMD (r = 0.419, p < 0.001). RAS blockade was independently associated with protection against FMD deterioration (OR 0.241, 95% CI 0.066-0.883, p = 0.032), whereas RA diameter (OR 0.079, 95% CI 0.009-0.720, p = 0.024) and procedure time (OR 1.156, 95% CI 0.989-1.350, p = 0.068) were associated with NMD deterioration, although the latter had borderline significance. CONCLUSIONS: Vasodilatory function of RA gets impaired in most patients following transradial procedures. RAS blockade seems to exert a protective role against deteriorating endothelium- dependent vasodilation, whereas smaller RA diameter and potentially longer procedure time are associated with impaired endothelium-independent vasodilation.