Serum osteoprotegerin level is independently related to subclinical left atrial mechanical function in patients with hypertension and diabetes.

OBJECTIVES: Previous studies showed that subclinical abnormal left atrial (LA) function could be diagnosed with LA speckle tracking evaluation long before chamber enlargement. Osteoprotegerin (OPG) is a member of the tumor necrosis factor (TNF) receptor superfamily and was recently found to be an indicator for adverse cardiovascular outcomes and a risk factor for new onset atrial fibrillation. The authors hypothesized that OPG values could predict LA mechanical dysfunction and LA remodeling assessed by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension (HT) and diabetes mellitus (DM). METHODS: A single center study was conducted including consecutive patients presenting to the authors' outpatient clinic. Enrolled patients needed to have been treated for HT and DM for at least 1 year. RESULTS: The study included 80 patients (mean age, 57.5 ± 8.3 years). Patients in the impaired LA strain group were older (p = 0.035), had lower low density lipoprotein (LDL) cholesterol (mg/dl) (p = 0.021), and higher OPG (pmol/l) (p = 0.004) values than patients in the normal LA strain group. Univariate logistic regression analysis demonstrated that age (p = 0.039), LDL cholesterol (mg/dl) (p = 0.025), and OPG (pmol/l) (p = 0.008) values were associated with impaired LA strain. Backward multivariate logistic regression analysis showed that LDL cholesterol (mg/dl) (OR: 0.982, CI 95% 0.964-0.999, p = 0.049) and OPG (pmol/l) (OR: 1.438, CI 95% 1.043-1.983, p = 0.027) were independently associated with impaired LA strain. CONCLUSION: In hypertensive and diabetic patients, higher OPG values were associated with impaired LA function assessed by 2D-STE. In this high-risk patient group, serum OPG can be used as a risk predictor for LA mechanical dysfunction.

Association between BNP levels and new-onset atrial fibrillation : A propensity score approach.

BACKGROUND: New-onset atrial fibrillation (NOAF), a common complication of acute ST-segment elevation myocardial infarction (STEMI), is associated with a poor prognosis. Several clinical and laboratory parameters are reported to be associated with NOAF in patients with STEMI. The aim of the present study was to evaluate the predictive value of plasma B­type natriuretic peptide (BNP) levels for NOAF development and long-term prognosis in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). PATIENTS AND METHODS: We retrospectively enrolled 1,928 patients with STEMI who underwent pPCI. After applying exclusion criteria, 1,057 patients were retained in the final study population. Patients with NOAF were compared with patients without NOAF in the entire study population and in a matched group. RESULTS: Patients with NOAF had a significantly higher average plasma BNP level (161 pg/ml, range: 72.3-432) than patients without NOAF in the study population (70.7 pg/ml, range: 70-129; p < 0.001) and in the matched group (104.6 pg/ml, range: 47.2-234.5; p = 0.014). Furthermore, the plasma BNP level was found to be an independent predictor of NOAF development (odds ratio [OR]: 1.003; 95% confidence interval [CI]: 1.000-1.005; p = 0.034) and mortality in the long-term follow-up (OR: 1.004; 95% CI: 1.002-1.006; p < 0.001). CONCLUSION: The present study found that a high plasma BNP level was significantly associated with NOAF development in STEMI patients, and was an independent predictor of NOAF development and all-cause mortality during long-term follow-up, regardless of other NOAF risk factors.

The relationship between the S-wave in lead 1 and recurrence of RVOT PVC ablation.

BACKGROUND: Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization. METHODOLOGY: A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015years were enrolled. All ECG parameters were measured before and after the ablation procedure. RESULTS: Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), ΔS1 area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and ΔS1 area (odds ratio:0.701 p:0,009) as predictors for recurrence. CONCLUSION: Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and ΔS1 area might be helpful for prediction of recurrence after CA.

Real-life data regarding acute procedural success and 1-year clinical outcome of desolve bioresorbable scaffolds.

OBJECTIVES: We aimed to evaluate the peri-procedural success of DESolve bio-resorbable scaffolds (BRSs) and analyzed real-life data about major cardiac events during 1-year follow-up. BACKGROUND: There is little information about real-life data of DESolve BRS which is a novel stent technology offering various advantages over drug eluting stents and commonly used in daily cardiology practice. METHODS: We conducted this single-center and non-randomized cross-sectional study from June 2015 through August 2016 in Medipol University Department of Cardiology and included 117 patients undergoing single or multivessel percutaneous coronary interventions (PCI) with novolimus-eluting BRS devices (152 scaffolds) (Elixir Medical Corporation). Study end points were acute device and procedural success, scaffold thrombosis and major adverse cardiac event (MACE) rates of DESolve BRS. RESULTS: Device success was 96.7% and procedural success was 99.3%. We detected MACE rate as 0.9% while clinical-driven target lesion revascularization was performed in one patient. None of the patients experienced scaffold thrombosis or death. Peri-procedural complications were reported in three patients. CONCLUSIONS: High rates of successful scaffold implantations, low rates of peri-procedural complications, and major cardiac events in long-term suggest that DESolve scaffolds can safely and effectively be used in daily intervention practice by particularly experienced operators.

Native Electrocardiographic QRS Duration after Cardiac Resynchronization Therapy: The Impact on Clinical Outcomes and Prognosis.

BACKGROUND: We investigated whether reversed electrical remodeling (RER), defined as narrowing of the native electrocardiographic QRS duration after cardiac resynchronization therapy (CRT), might predict prognosis and improvement in echocardiographic outcomes. METHODS AND RESULTS: A total of 110 CRT recipients were retrospectively analyzed for the end points of death and hospitalization during 18 ± 3 months. Native QRS durations were recorded at baseline and 6 months after CRT (when pacing was switched off to obtain an electrocardiogram) to determine RER. CRT response and mitral regurgitation (MR) improvement were defined as ≥15% reduction in left ventricular end-systolic volume and absolute reduction in regurgitant volume (RegV) at 6 months, respectively. Overall, 48 patients (44%) had RER, which was associated with functional improvement (77% vs 34%; P < .001) and CRT response (81% vs 52%; P < .001) compared with those without RER. The change in the intrinsic QRS duration correlated with the reduction in RegV (r = 0.51; P < .001) and in tenting area (r = 0.34; P < .001). RER was a predictor of MR improvement (P = .023), survival (P = .043), and event-free survival (P = .028) according to multivariate analyses. CONCLUSIONS: Narrowing of the intrinsic QRS duration is associated with functional and echocardiographic CRT response, reduction in MR, and favorable prognosis after CRT.

Predicting Ventricular Arrhythmias in Cardiac Resynchronization Therapy: The Impact of Persistent Electrical Dyssynchrony.

BACKGROUND: Although response to cardiac resynchronization therapy (CRT) has been conventionally assessed with left ventricular volume reduction, ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) are of critical importance associated with unfavorable outcomes even in the "superresponders" to therapy. We evaluated the predictors of VT/VF and the association of residual dyssynchrony during follow-up. METHODS: Ninety-five patients receiving CRT were followed-up for 9 ± 3 months. Post-CRT dyssynchrony was defined as a prolonged QRS duration (QRSd) for persistent electrical dyssynchrony (ED), and a Yu index ≥ 33 ms for persistent mechanical dyssynchrony. The first VT/VF episode, including nonsustained VT detected on device interrogation and/or appropriate antitachycardia pacing or shock for VT/VF, were the end points of the study. RESULTS: Forty-five patients who reached the study end points had significantly lower mean ΔQRS (baseline QRSd - post-CRT QRSd) values than those without VT/VF (-20.8 ± 28.9 ms vs -6.6 ± 30.7 ms, P = 0.022). Both the baseline and post-CRT QRSds, along with the Yu index values, were not different in two groups. Patients with VT/VF were statistically more likely to have persistent ED (38% vs 9%, P = 0.021). Kaplan-Meier curves showed that a negative ΔQRS was associated with a higher incidence of VT/VF during follow-up (P = 0.016). A multivariate Cox model revealed that QRS prolongation was an independent predictor of VT/VF after CRT (P = 0.029). CONCLUSIONS: A negative ΔQRS, also called persistent ED, is associated with VT/VF. Narrowest possible QRSd might be a reliable goal of both implantation and optimization of devices to reduce arrhythmic events after CRT.

Evaluation of Aortic Paravalvular Leak: A Special Reference for Anatomical Localization.

BACKGROUND AND AIM OF THE STUDY: Paravalvular leakage (PVL) remains an unavoidable complication of heart valve surgery and in its severe forms may lead to heart failure and hemolysis. The study aim was to evaluate the echocardiographic, clinical, surgical and laboratory characteristics of patients with aortic PVL. METHODS: A total of 77 aortic PVL patients underwent transthoracic and transesophageal echocardiography examinations. Clinical, echocardiographical and surgical findings were also recorded. RESULTS: Among the 77 patients, 21 (27.3%) had mild, 33 (42.8%) had moderate and 23 (29.9%) had severe aortic PVL. Seventeen patients (22.1%) had moderate-to-severe hemolysis and had a higher incidence of multiple PVL compared to those with no or mild hemolysis. Moderate- to-severe PVL was more frequent between the non-coronary and the left coronary sinus annuli, especially adjacent to the left main coronary artery ostium. Percutaneous closure was performed in five patients. Eleven patients underwent surgical repair, and the localizations of PVL were in accordance with echocardiographic findings. CONCLUSIONS: Aortic PVL occurs more frequently between the non-coronary sinus and the left coronary sinus annuli, which may be associated with multiple factors. Difficulties in seating the prosthesis due to the steep angulation of the commissure and annulus, the avoidance of deep sutures, and focal annular calcification may make this region prone to injury and leakage.

Histopathological and Immunohistochemical Evaluation of Pannus Tissue in Patients with Prosthetic Valve Dysfunction.

BACKGROUND: Prosthetic valve dysfunction due to pannus formation is a rare but serious complication. Currently, limited data are available concerning the pathogenesis and immunohistochemical properties of pannus. The study aim was to investigate the morphological, histopathological and immunohistochemical characteristics of pannus formation in patients with prosthetic valve dysfunction. METHODS: A total of 35 patients (10 males, 25 females; mean age 44 ± 16 years) who had undergone re-do valve surgery due to prosthetic valve obstruction was enrolled in the study. Immunohistochemical studies were aimed at evaluating the expression of alphasmooth muscle actin (α-SMA) and desmin in myofibroblasts and smooth muscle cells; epithelial membrane antigen (EMA) in epithelial cells; and CD34, Factor VIII and vascular endothelial growth factor (VEGF) in endothelial cells. Matrix metalloproteinases (MMPs) -2 and -9, and transforming growth factor-beta (TGF-ß) were used to demonstrate cytokine release from macrophages, leukocytes, fibroblasts and myofibroblasts. RESULTS: Pannus appeared as a tough and thick tissue hyperplasia which began from outside the suture ring in the periannular region and extended to the inflow and outflow surfaces of the prosthetic valves. Histopathological analysis showed the pannus tissue to consist of chronic inflammatory cells (lymphocytes, plasma cells, macrophages and foreign body giant cells), spindle cells such as myofibroblasts, capillary blood vessels and endothelial cells laying down the lumens. Calcification was present in the pannus tissue of 19 explanted prostheses. Immunohistochemical studies revealed positive α-SMA expression in all patients, whereas 60.5% of patients were positive for desmin, 50% for EMA, 42.1% for VEGF, 39.5% for TBF-ß, 42.1% for MMP-2, 86.8% for CD34, and 97.4% for Factor VIII. MMP-9 was negative in all patients. CONCLUSIONS: Pannus tissue appears to be formed as the result of a neointimal response in periannular regions of prosthetic valves that consist of periannular tissue migration, myofibroblast and extracellular matrix proliferation with vascular components. It is a chronic active process in which mediators such as TGF-ß, VEGF and MMP-2 play roles in both matrix formation and degradation.

Changes in Electrocardiographic P Wave Parameters after Cryoballoon Ablation and Their Association with Atrial Fibrillation Recurrence.

BACKGROUND: Changes in P wave parameters after circumferential pulmonary vein isolation (CPVI) have been previously identified. In this study, we aimed to determine the changes in P wave parameters surface electrocardiogram (ECG) after cryoballoon ablation (CBA) for atrial fibrillation (AF) and evaluate their relationship with AF recurrence. METHODS: Sixty-one patients (mean age 53 ± 11 years, 50.8% male) with paroxysmal AF who underwent CBA were enrolled. A surface ECG was obtained from all patients immediately before the procedure, and repeated 12 hours after the procedure. P wave amplitude (Pamp), P wave duration (Pwd), and P wave dispersion (Pdis) values in preprocedural and postprocedural ECGs were measured and compared. Recurrence rates of AF in 3, 6, and 9 months following ablation were recorded for all patients. Changes in P wave parameters were compared between patients with and without AF recurrence. RESULTS: Compared to preprocedural measurements, Pamp (from 0.58 ± 0.18 mV at baseline to 0.48 ± 0.17 mV, P < 0.001), Pwd (from 109.72 ± 18.43 ms at baseline to 91.36 ± 22.53 ms, P < 0.001), and Pdis (from 55.44 ± 20.45 ms at baseline to 45.30 ± 15.31 ms, P < 0.001) were significantly decreased after CBA. The difference in Pamp between pre- and postprocedural values (∆Pamp) was significantly higher in patients without AF recurrence compared to those with recurrence (0.10 ± 0.06 mV vs 0.04 ± 0.01 mV, P = 0.002). There was no difference in Pwd difference (∆Pwd) and Pdis difference (∆Pdis) between patients with and without AF recurrence (P > 0.05). CONCLUSION: Pamp, Pwd, and Pdis parameters exhibited significant decrease after CBA compared to preprocedural measurements. Decreased Pamp was shown to be a predictor for good clinical outcomes following CBA.

Adjusting the QRS Duration by Body Mass Index for Prediction of Response to Cardiac Resynchronization Therapy: Does One QRS Size Fit All?

BACKGROUND: QRS duration (QRSd) is known to be affected by body weight and length. We tested the hypothesis that adjusting the QRSd by body mass index (BMI) may provide individualization for patient selection and improve prediction of cardiac resynchronization therapy (CRT) response. METHODS: A total of 125 CRT recipients was analyzed to assess functional (≥1 grade reduction in NYHA class) and echocardiographic (≥15% reduction in LVESV) response to CRT at 6 months of implantation. Baseline QRSd was adjusted by BMI to create a QRS index (QRSd/BMI) and tested for prediction of CRT response in comparison to QRSd. RESULTS: Overall, 81 patients (65%) responded to CRT volumetrically. The mean QRS index was higher in CRT responders compared to nonresponders (6.2 ± 1.1 vs 5.2 ± 0.8 ms.m(2) /kg, P < 0.001). There was a positive linear correlation between the QRS index and the change in LVESV (r = 0.487, P < 0.001). Patients with a high QRS index (≥5.5 ms.m(2) /kg, derived from the ROC analysis, AUC = 0.787) compared to those with a prolonged QRSd (≥150 ms, AUC = 0.729) had a greater functional (72% vs 28%, P < 0.001) and echocardiographic (80% vs 44%, P < 0.001) improvement at 6 months. QRS index predicted CRT response at regression analysis. CONCLUSIONS: Indexing the QRSd by BMI improves patient selection for CRT by eliminating the influence of body weight and length on QRSd. QRS index is a novel indicator that provides promising results for prediction of CRT response.

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.

Ultraslow thrombolytic therapy: A novel strategy in the management of PROsthetic MEchanical valve Thrombosis and the prEdictors of outcomE: The Ultra-slow PROMETEE trial.

BACKGROUND: Low-dose (25mg), slow infusion (6hours) of tissue-type plasminogen activator (t-PA) with repetition as needed has been shown to provide effective and safer thrombolysis in patients with prosthetic valve thrombosis (PVT). Further prolonging the infusion time may be rational with regard to reducing complication rates without reducing success rates. We aimed to investigate the efficacy and safety of ultraslow (25hours) infusion of low-dose (25mg) alteplase (t-PA) for PVT. METHODS AND RESULTS: Transesophageal echocardiography-guided thrombolytic therapy (TT) was administered to 114 patients with PVT in 120 different episodes between 2009 and 2013 in a single center. Prosthetic valve thrombosis was obstructive in 77 (64.2%) and nonobstructive in 43 (35.8%) episodes. Ultraslow infusion (25hours) of low-dose (25mg) t-PA, as the TT regimen, was used in all patients admitted with PVT. The end points were thrombolytic success, mortality, and complication rates. The overall success rate of TT was 90% (95% CI 0.85-0.95). The univariate predictors of an unsuccessful result were higher New York Heart Association (NYHA) class, thrombus cross-sectional area, duration of suboptimal anticoagulation, lower baseline valve area, and presence of atrial fibrillation. The NYHA class was the only independent predictor of TT failure by multiple variable analysis. The overall complication rate was 6.7% (3.3% nonfatal major, 2.5% minor, and 0.8% death). The predictors of complications were presence of atrial fibrillation, higher NYHA class, and thrombus area. CONCLUSION: Ultraslow (25hours) infusion of low-dose (25mg) t-PA without bolus appears to be associated with quite low nonfatal complications and mortality for PVT patients without loss of effectiveness, except for those with NYHA class IV.

Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention.

BACKGROUND: In this study, we aimed to investigate the impact of prophylactic intracoronary adenosine administered during percutaneous coronary intervention (PCI) due to unstable angina pectoris on myonecrosis by measuring post-procedural levels of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB). METHODS: A total of 122 patients with unstable angina undergoing PCI were included in this single-center, double-blind, randomized study. The patients were randomly allocated to adenosine and placebo groups. In the adenosine group, a single-dose of intracoronary adenosine (100 µg for the right coronary artery and 150 µg for the left coronary artery) was administered. Primary endpoint was post-PCI myonecrosis, which was defined as abnormal levels of periprocedural cTnI. Secondary endpoints were defined as elevated cTnI levels [5 × upper limit of normal (ULN)], abnormal CK-MB levels, angiographic coronary flow measured by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC), the cumulative incidence of in-hospital death and in-hospital urgent target vessel revascularization (TVR). RESULTS: Clinical and angiographic characteristics of both adenosine (61 patients, 61 ± 9 years) and placebo (61 patients, 59 ± 10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal cTnI levels in the adenosine group were significantly lower than the placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 × ULN (21 % vs. 31 %, p: 0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in both groups. Post-procedural TFCs in the adenosine group were significantly lower than the placebo group (24 ± 4 vs. 27 ± 5, p: 0.004). In-hospital events including death and urgent TVR were not observed in either group. CONCLUSION: Intracoronary administration of single-dose adenosine in patients with unstable angina undergoing PCI is associated with decreased periprocedural myonecrosis and improved coronary blood flow.

Relation of epicardial fat thickness to subclinical right ventricular dysfunction assessed by strain and strain rate imaging in subjects with metabolic syndrome: a two-dimensional speckle tracking echocardiography study.

BACKGROUND: Right ventricular (RV) function is known to be impaired in the presence of metabolic syndrome (MetS). Epicardial adipose tissue is a metabolically active organ that generates various bioactive molecules, which might affect cardiac function and morphology. Thus, we hypothesized that RV dysfunction in patients with MetS may be related to increased epicardial fat thickness (EFT) in these patients. In patients with MetS, we aimed to assess the relation of EFT with RV function using two-dimensional speckle tracking echocardiography (2DSTE)-derived strain and strain rate imaging. METHODS: The study involved 76 subjects with MetS and 61 subjects without MetS. Biventricular structure and function together with EFT were evaluated by conventional echocardiography. RV free and septal walls strain (RVFW-S & RVSW-S), systolic and early diastolic strain rates (RVSRs & RVSRe) were evaluated by 2DSTE. RESULTS: Epicardial fat thickness was significantly higher in subjects with MetS (6.45 ± 1.48 mm vs. 5.49 ± 1.05 mm, P < 0.001). RVFW-S (-22.95 ± 4.97% vs. -24.96 ± 3.63%; P = 0.007), RVSRs (1.53 ± 0.33/sec vs. -1.70 ± 0.33/sec; P = 0.002), and RVSRe (1.40 ± 0.44/sec vs. 1.75 ± 0.49/sec; P < 0.001) were all lower in subjects with MetS, while RVSW-S did not differ. Multiple regression analysis showed that EFT was independently associated with RVFW-S (ß = -0.547, P < 0.001), RVSRs (ß = -0.332, P = 0.001), and RVSRe (ß = -0.187, P = 0.019) in subjects with MetS. CONCLUSIONS: Metabolic syndrome is associated with subclinical RV systolic and diastolic dysfunction. In subjects with MetS, increased EFT is independently related to RV systolic and diastolic dysfunction.

Association of Mitral Annular Calcification with Left Ventricular Mechanics: A Speckle Tracking Study.

BACKGROUND: Mitral annular calcification (MAC) is a common echocardiographic finding in clinical practice and is associated with cardiovascular risk factors and atherosclerosis. However, data regarding left ventricular (LV) functions are lacking. We aimed to evaluate the relationship between MAC and LV mechanical functions with the utility of two-dimensional speckle tracking echocardiography (2DSTE). METHODS: The study involved 91 patients with MAC and 48 control subjects. Mitral annular thickness of 1-2 mm was reported as mild, 2-5 mm as moderate, and >5 mm as severe MAC. All patients underwent 2D echocardiography. RESULTS: MAC was observed in 91 (65.5%) patients. Of LV diastolic parameters, E/Em ratio, LAVI, LV mass index, and t-LV UR were increased. Of LV systolic parameters, GLS and Sm were decreased, whereas Ar, Ar-rate systole, peak LV twist, peak LV twist rate, LV-tor, and MPI were increased, which were all correlated with presence and severity of MAC. Multivariate linear regression analysis showed that LV mass index (ß = 0.225, P = 0.012), t-LV UR (ß = 0.370, P < 0.001), LV mass index (ß = 0.183, P = 0.025), MPI (ß = 0.288, P < 0.001), and GLS (ß = -0.385, P < 0.001) were significantly associated with MAC severity. CONCLUSION: The presence and severity of MAC is associated with impaired LV systolic and diastolic functions. Therefore, preventive strategies might be taken in patients with MAC to avoid LV systolic and diastolic dysfunction.

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.

Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease.

We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r = 0.495, p < 0.001). In multivariate regression analysis male sex (B = 0.169, p < 0.001, CI95% = 0.270-0.735), Log10 SYNTAX score (B = 0.282, p < 0.001, CI95% = 0.431-0.782), Log10 creatinine (B = 0.081, p = 0.036, CI95% = 0.043-1.239), low-density lipoprotein (B = 0.114, p = 0.003, CI95% = 0.001-0.006) and high-density lipoprotein (B = -0.360, p < 0.001, CI95% = -0.063 to -0.041) were the independent predictors of Trans Atlantic Inter-Society Consensus II class. We have shown that patients with complex peripheral artery disease had complex coronary artery disease.

Evaluation of Left Ventricular Function and its Relationship With Multidimensional Grading System (BODE Index) in Patients With COPD.

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients however data regarding left ventricle (LV) function in COPD is limited. We, in this study, aimed to evaluate the LV systolic function and its relation to BODE index in COPD patients with the utility of two-dimensional speckle tracking echocardiography (2D-STE). The study involved 125 COPD patients and 30 control subjects. All patients underwent 2D-echocardiography, pulmonary function tests and -minute walk tests. The patients were divided into four quartiles according to BODE index score. COPD patients had lower mitral annulus systolic velocity (Sm), average global longitudinal strain (GLS), average global longitudinal strain rate systolic (GLSRs), average GLSR early diastolic (GLSRe), average GLSR late diastolic (GLSRa), tricuspid annular plane systolic excursion (TAPSE) and peak systolic myocardial velocity (Sm-RV) (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p = 0.002 respectively) than control subjects. There were significant differences between BODE index quartiles in terms of Sm, average GLS and average GLSRs. Patients were divided into two groups according to median value of GLS (> -18.6 and ≤ -18.6). BODE index quartiles were found to be independent predictors of decreased GLS in multivariate logistic regression analysis (p = 0.030). Increased BODE index was associated with impaired LV mechanics in patients with COPD.

Aortic arch calcification is strongly associated with coronary artery calcification.

BACKGROUND: We aimed to investigate the association between aortic arch and coronary artery calcification (CAC). We postulated that low- and high-risk CAC scores could be predicted with the evaluation of standard chest radiography for aortic arch calcification (AAC). PATIENTS AND METHODS: Consecutive patients who were referred for a multidetector computerized tomography (MDCT) examination were enrolled prospectively. All patients were scanned using a commercially available 64-slice MDCT scanner for the evaluation of CAC score. A four-point grading scale (0, 1, 2 and 3) was used to evaluate AAC on the standard posterior-anterior chest radiography images. RESULTS: The study group consisted of 248 patients. Median age of the study group was 52 (IQR: 10) years, and 165 (67 %) were male. AAC grades (r = 0.676, p < 0.0001) and age (r = 0.518, p < 0.0001) were significantly and positively correlated with CAC score. Presence of AAC was independently associated with the presence of CAC (OR: 11.20, 95 % CI 4.25 to 29.52). An AAC grade of ≥ 2 was the strongest independent predictor of a high-risk CAC score (OR: 27.42, 95 % CI 6.09 to 123.52). Receiver operating characteristics curve analysis yielded a strong predictive ability of AAC grades for a CAC score of ≥ 100 (AUC = 0.892, P < 0.0001), and ≥ 400 (AUC = 0.894, P < 0.0001). Absence of AAC had a sensitivity, specificity and accuracy of 90 %, 84 % and 89 %, respectively, for a CAC score of < 100. An AAC grade of ≥ 2 predicted a CAC score of ≥ 400 with a sensitivity, specificity and accuracy of 68 %, 98 % and 95 %, respectively. CONCLUSIONS: AAC is a strong and independent predictor of CAC. The discriminative performance of AAC is high in detecting patients with low- and high-risk CAC scores.

Prediction of radial artery diameter in candidates for transradial coronary angiography: Is occupation a factor?

OBJECTIVE: Transradial approach (TRA) for coronary angiography is a popular alternative approach to transfemoral coronary angiography due to the infrequent occurrence of access site complications such as bleeding, hematoma and pseudoaneursym formation. However, not all patients are suitable for TRA. This study aimed to determine the predictors of radial artery diameter in patients who are candidates for TRA. METHODS: The study included 222 consecutive patients who underwent TRA due to suspected stable coronary artery disease. Radial artery diameter was evaluated prior to the procedure using B-mode ultrasonography. RESULTS: Radial artery diameter was correlated with wrist circumference (r=0.539, p<0.001), height (r=0.258, p<0.001), weight (r=0.237, p<0.001), body mass index (r=0.167, p=0.013), shoe size (r=0.559, p<0.001), and pulse pressure (r=-0.161, p=0.016). The right radial artery was larger in men than in women (2.73±0.39 mm vs. 2.15±0.35 mm, p<0.001), and smaller in patients with sedentary office work than in physically active outdoor workers (2.42±0.45 mm vs. 2.81±0.37 mm, p<0.001). Wrist circumference (b=0.044, p<0.001, confidence interval (CI) 95%= 0.025-0.062), shoe size (b=0.075, p=<0.001, CI 95%=0.039-0.112) and occupation (b=0.228, p<0.001, CI 95%=0.138-0.318) were the independent predictors of radial artery diameter in regression analysis. CONCLUSION: In addition to shoe size and wrist circumference, occupation may be an important predictor of radial artery diameter, and it should be evaluated with other clinical parameters in the prediction of radial artery diameter.