Exercise Prevents Glucocorticoid-Induced Myocardial 4-Hydroxynonenal Production.

PURPOSE: Long-term administration of glucocorticoids (GCs) increases myocardial oxidative stress. 4-Hydroxynonenal (4-HNE) protein adducts, a marker of oxidative damage, have been associated with several cardiovascular diseases, including atherosclerosis, cardiac hypertrophy, cardiomyopathy, and ischemia-reperfusion injury. Exercise training has been shown to have a protective effect on the heart by lowering the level of oxidative stress in cardiomyocytes. Therefore, we aimed to investigate the effect of long-term dexamethasone treatment and exercise training on myocardial 4-HNE levels. METHODS: Twenty-four female Wistar albino rats were assigned to sedentary control-saline treated (C, n = 8), sedentary-dexamethasone treated (D, n = 8), and exercise training-dexamethasone treated (DE, n = 8) groups. Daily dexamethasone was injected for 28 days at a 1 mg kg-1 dose, while C animals were injected with the same volume of saline subcutaneously. DE animals underwent an exercise training protocol of 60 min/day, 5 days a week, at 25 m/min-1 (0% grade) for 28 days. Left ventricular 4-HNE, Hsp72 levels, and pHsp25/Hsp25 ratio were determined by Western blot. RESULTS: The administration of dexamethasone led to a significant elevation in 4-HNE levels in the myocardium of adult rats (p < 0.05; D vs. C). The concurrent implementation of exercise training impeded this increase (p > 0.05; DE vs. C). Exercise training induced a threefold increase in myocardial Hsp72 expression (p < 0.001; DE vs. C and D) and attenuated the dexamethasone-induced increase in Hsp25 phosphorylation (p < 0.05; C vs. D) (p < 0.001; DE vs. D). CONCLUSION: Our results indicate that long-term administration of dexamethasone is associated with an increase in cardiac 4-HNE levels, which is hindered by the addition of exercise training.

Long-term Dexamethasone Treatment Increases Cardiac Galectin-3 Levels.

PURPOSE: Glucocorticoids, which are widely prescribed around the world, cause cardiac remodeling in long-term treatment by triggering insulin resistance and increasing blood pressure. However, its role in cardiac remodeling remains unclear. Galectin-3 (gal-3) is a member of a beta-galactoside-binding animal lectins, upregulated as a result of insulin resistance and in the pressure-overloaded myocardium and regulate cardiac remodeling. We hypothesized that gal-3 may be upregulated in the myocardium with prolonged use of glucocorticoids and associated with cardiac hypertrophy. METHODS: To examine the involvement of glucocorticoids in gal-3 levels in rat myocardium, sixteen female Wistar Albino rats were assigned to control (C; n = 8) and dexamethasone (Dex; n = 8) groups. Daily dexamethasone was injected subcutaneously for 28 days at a dose of 1 mg.kg-1. Control animals were injected with the same volume of saline. The body weight and heart weights were determined. Gal-3 levels in myocardium were determined by Western blot. RESULTS: Our data shows that dexamethasone administration resulted in significant increase in heart weight (p < 0.05) and HW/BW ratios (p < 0.001) and 28 days of dexamethasone administration with the dose of 1 mg.kg-1 caused a twofold increase in the gal-3 expression in the left ventricle (p < 0.001). CONCLUSION: The finding of the current study is the first to show that dexamethasone causes an increase in gal-3 levels in myocardium. Our study provides an important step in the development of possible therapeutics by determining that dexamethasone causes an increase in gal-3 levels in the myocardium and raises awareness about the follow-up of patients receiving long-term glucocorticoid therapy.

Possible value of galectin-3 on follow-up of cardiac remodeling during glucocorticoid treatment.

Glucocorticoids are among the most prescribed drugs globally due to their potent anti-inflammatory and immunosuppressive properties. Although they have positive effects on the treatment of various disease states; long-term administration is associated with high blood pressure, insulin resistance, and susceptibility to type 2 diabetes. The heart attempts to cope with increased blood pressure and a decrease in glucose utilization by developing pathological cardiac remodeling. However, in this process, cardiac fibrosis formation and deterioration in heart structure and functions occur. Galectin-3, a member of the ß-galactoside binding lectins, is consistently associated with inflammation and fibrosis in the pathogenesis of various disease states including insulin resistance and heart failure. Galectin-3 expression is markedly increased in activated macrophages and a subset of activated fibroblasts and vascular cells. Also, failing and remodeling myocardium show increased Gal-3 expression and elevated Gal-3 levels are related to heart failure severity and prognosis. Furthermore, Gal-3-related pathways are recently suggested as therapeutic targets both pharmacologically and genetically to increase insulin sensitivity in vivo. The objective of this review is to provide a summary of our current understanding of the role of glucocorticoid-associated insulin resistance, which is important for some cardiac events, and the potential role of galectin in this pathophysiological process.

Value of point-of-care neutrophil gelatinase associated lipocalin in early diagnosis of acute kidney injury in patients with left ventricular systolic dysfunction after coronary angiography.

BACKGROUND: Increased neutrophil gelatinase-associated lipocalin (NGAL) levels are associated with toxic or ischemic renal injury. OBJECTIVE: This study aimed to assess the usefulness of serial NGAL measurements with a point-of-care assay in patients with left ventricular systolic dysfunction (LVSD) for earlier detection of contrast-induced nephropathy (CIN). MATERIALS AND METHODS: A total of 84 patients with LVSD patients referred for coronary angiography were consecutively enrolled in the study. The study population was divided into two groups as the CIN and the non-CIN groups according to the CIN's determination. The serum creatinine levels were calculated 24 h before the procedure and at the 48th and 72nd h after the cardiac catheterization. The plasma NGAL concentration was measured before and at 4 and 24 h after the cardiac catheterization. RESULTS: Baseline and serial NGAL levels were significantly higher in patients with CIN compared to the patients without CIN. NGAL 24th h levels after the index procedure were found to be an independent and significant predictor of CIN in multivariate analysis. CONCLUSIONS: Serial point-of-care NGAL measurements might help earlier detection of CIN in patients with heart failure after coronary angiography.

Clinically significant bleeding with low-dose rivaroxaban versus aspirin, in addition to P2Y12 inhibition, in acute coronary syndromes (GEMINI-ACS-1): a double-blind, multicentre, randomised trial.

BACKGROUND: Dual antiplatelet therapy (DAPT), aspirin plus a P2Y12 inhibitor, is the standard antithrombotic treatment following acute coronary syndromes. The factor Xa inhibitor rivaroxaban reduced mortality and ischaemic events when added to DAPT, but caused increased bleeding. The safety of a dual pathway antithrombotic therapy approach combining low-dose rivaroxaban (in place of aspirin) with a P2Y12 inhibitor has not been assesssed in acute coronary syndromes. We aimed to assess rivaroxaban 2·5 mg twice daily versus aspirin 100 mg daily, in addition to clopidogrel or ticagrelor (chosen at investigator discretion before randomisation), for patients with acute coronary syndromes started within 10 days after presentation and continued for 6-12 months. METHODS: In this double-blind, multicentre, randomised trial (GEMINI-ACS-1) done at 371 clinical centres in 21 countries, eligible patients were older than 18 years with unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) or ST segment elevation myocardial infarction (STEMI), with positive cardiac biomarkers and either ischaemic electrocardiographic changes or an atherosclerotic culprit lesion identified during angiography. Participants were randomly assigned (1:1) within 10 days after admission for the index acute coronary syndromes event to either aspirin or rivaroxaban based on a computer-generated randomisation schedule. Randomisation was balanced by using randomly permuted blocks with size of four and was stratified based on the background P2Y12 inhibitor (clopidogrel or ticagrelor) intended to be used at the time of randomisation. Investigators and patients were masked to treatment assignment. Patients received a minimum of 180 days of double-blind treatment with rivaroxaban 2·5 mg twice daily or aspirin 100 mg daily. The choice of clopidogrel or ticagrelor during trial conduct was not randomised and was based on investigator preference. The primary endpoint was thrombolysis in myocardial infarction (TIMI) clinically significant bleeding not related to coronary artery bypass grafting (CABG; major, minor, or requiring medical attention) up to day 390. Primary analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT02293395. FINDINGS: Between April 22, 2015, and Oct 14, 2016, 3037 patients with acute coronary syndromes were randomly assigned; 1518 to receive aspirin and 1519 to receive rivaroxaban. 1704 patients (56%) were in the ticagrelor and 1333 (44%) in the clopidogrel strata. Median duration of treatment was 291 days (IQR 239-354). TIMI non-CABG clinically significant bleeding was similar with rivaroxaban versus aspirin therapy (total 154 patients [5%]; 80 participants [5%] of 1519 vs 74 participants [5%] of 1518; HR 1·09 [95% CI 0·80-1·50]; p=0·5840). INTERPRETATION: A dual pathway antithrombotic therapy approach combining low-dose rivaroxaban with a P2Y12 inhibitor for the treatment of patients with acute coronary syndromes had similar risk of clinically significant bleeding as aspirin and a P2Y12 inhibitor. A larger, adequately powered trial would be required to definitively assess the efficacy and safety of this approach. FUNDING: Janssen Research & Development and Bayer AG.

Combination of change in hematological parameters with exercise stress test to predict coronary artery disease.

OBJECTIVE: Treadmill exercise stress testing for identifying patients with a higher likelihood of coronary artery disease (CAD) before elective coronary angiography is recommended in the current guidelines. In this study, we aimed to evaluate the changes in the hematological parameters before and after exercise stress test in relation with the presence of CAD. METHODS: A total of 113 patients with chest pain who underwent treadmill exercise testing and coronary angiography were included in this study. RESULTS: Neutrophil count (4.38±0.99 vs 5.19±0.93, P<.001), and neutrophil to lymphocyte ratio (NLR) (2.04±0.63 vs 2.41±0.78, P<.001) were significantly elevated after treadmill exercise test in all the patients. Increase in the NLR after exercise test was significantly higher in patients with positive exercise test (n=68) than negative exercise test (n=45) (0.49±0.58 vs 0.19±0.44, P=.016). The sensitivity and specificity of treadmill exercise testing according to coronary angiography was 79% and 64%, respectively. A cut-off point of 0.2 for the change in the NLR in addition to positive treadmill exercise testing had 91% sensitivity and 92% specificity in predicting significant coronary artery stenosis (AUC:0.913, 95% CI: 0.805-1.000, P<.001). CONCLUSIONS: Neutrophil to lymphocyte ratio is an important inflammatory marker that can contribute to treadmill ECG testing in predicting CAD.

Platelet to Lymphocyte Ratio on Admission and Prognosis in Patients with Acute Cardiogenic Pulmonary Edema.

BACKGROUND: Acute heart failure is a heterogenous syndrome defined by a number of factors, such as its physiopathology, clinical picture, time of onset, and relation to acute coronary syndrome. Acute cardiogenic pulmonary edema (ACPE) constitutes approximately 10-20% of acute heart failure syndromes, and it is the most dramatic symptom of left heart failure. Platelet to lymphocyte ratio (PLR) is a relatively novel inflammatory marker that can be utilized for prognosis in various disease processes. OBJECTIVE: In this study, we investigated the value of the PLR for the prediction of mortality in patients with ACPE. METHODS: A total of 115 patients hospitalized with a diagnosis of ACPE were included in this study. The patients were divided into tertile groups according to their PLR values: high (PLR > 194.97), medium (98.3-194.97), and low tertile (PLR < 98.3). RESULTS: We compared the PLR groups for in-hospital mortality and total mortality after discharge. Multivariate Cox regression analysis showed that PLR was independently associated with total mortality (hazard ratio 5.657; 95% confidence interval 2.467-12.969; p < 0.001). Survival analysis using the Kaplan-Meier curve showed that the high-PLR group had a significantly higher mortality rate than the other groups. CONCLUSIONS: We showed an association between high PLR and mortality in patients with ACPE. PLR, together with other inflammatory markers and clinical findings, may be used as an adjunctive parameter for the stratification of mortality risk, hospitalization, or discharge criteria scoring.

The relationship between fragmented QRS and functional significance of coronary lesions.

BACKGROUND: Recently fragmented QRS (fQRS) on electrocardiography (ECG) has been introduced as a predictor of myocardial scarring and myocardial ischemia in coronary artery disease (CAD). OBJECTIVE: The aim of this study was to investigate the relationship between fQRS and fractional flow reserve (FFR) results in patients with the intermediate degree of coronary artery stenosis. METHODS: A total of 301 consecutive patients who underwent coronary angiography (CAG) and FFR measurement for intermediate coronary artery stenosis were included in the study. The study patients were divided into two groups: the low FFR group (FFR value of ≤0.80) and normal FFR (FFR value of >0.80) group. Both groups were compared in terms of the presence of fQRS. RESULTS: Of 301 patients, fQRS was detected in 128 (42.5%) and low FFR was detected in 115 (38.2%). In the low FFR group, fQRS was significantly higher (P<0.001). Multivariate analysis showed that fQRS was an independent predictor of myocardial ischemia in patients with intermediate coronary stenosis (OR=7.202, CI 95%, 4.195-12.367; p<0.001). The presence of fQRS had 70% sensitivity and 74% specificity for the prediction of FFR≤0.80. CONCLUSION: In clinical practice, the presence of fQRS on ECG is associated with myocardial ischemia in patients with intermediate coronary stenosis.

Intracoronary epinephrine in the treatment of refractory no-reflow after primary percutaneous coronary intervention: a retrospective study.

BACKGROUND: Despite the advances in medical and interventional treatment modalities, some patients develop epicardial coronary artery reperfusion but not myocardial reperfusion after primary percutaneous coronary intervention (PCI), known as no-reflow. The goal of this study was to evaluate the safety and efficacy of intracoronary epinephrine in reversing refractory no-reflow during primary PCI. METHODS: A total of 248 consecutive STEMI patients who had undergone primary PCI were retrospectively evaluated. Among those, 12 patients which received intracoronary epinephrine to treat a refractory no-reflow phenomenon were evaluated. Refractory no-reflow was defined as persistent TIMI flow grade (TFG) ≤ 2 despite intracoronary administration of at least one other pharmacologic intervention. TFG, TIMI frame count (TFC), and TIMI myocardial perfusion grade (TMPG) were recorded before and after intracoronary epinephrine administration. RESULTS: A mean of 333 ± 123 mcg of intracoronary epinephrine was administered. No-reflow was successfully reversed with complete restoration of TIMI 3 flow in 9 of 12 patients (75%). TFG improved from 1.33 ± 0.49 prior to epinephrine to 2.66 ± 0.65 after the treatment (p < 0.001). There was an improvement in coronary flow of at least one TFG in 11 (93%) patients, two TFG in 5 (42%) cases. TFC decreased from 56 ± 10 at the time of no-reflow to 19 ± 11 (p < 0.001). A reduction of TMPG from 0.83 ± 0.71 to 2.58 ± 0.66 was detected after epinephrine bolus (p < 0.001). Epinephrine administration was well tolerated without serious adverse hemodynamic or chronotropic effects. Intracoronary epinephrine resulted in significant but tolerable increase in heart rate (68 ± 13 to 95 ± 16 beats/min; p < 0.001) and systolic blood pressure (94 ± 18 to 140 ± 20; p < 0.001). Hypotension associated with no-reflow developed in 5 (42%) patients. During the procedure, intra-aortic balloon pump counterpulsation was required in two (17%) patients, transvenous pacing in 2 (17%) cases, and both intra-aortic balloon counterpulsation and transvenous pacing in one (8%) patients. One patient (8%) died despite all therapeutic measures. CONCLUSION: Intracoronary epinephrine may become an effective alternative in patients suffering refractory no-reflow following primary PCI.

Asymptomatic Tricuspid Stenosis Following a Complex Lead Extraction Procedure.

The number of transvenous extraction procedures for leads of intracardiac rhythm devices increased recently and the most common reason for lead extraction is device infection. In some cases, combined use of two different techniques is necessary. Long-term results of this approach are not clear. In this case report, we present a patient with biventricular implantable cardioverter defibrillator who underwent percutaneous hardware removal due to recurrent pacemaker pocket infections. Mechanical dilator sheath removal and Needle's Eye Snare were used in the same patient. Although asymptomatic, tricuspid stenosis was detected three years after the operation.

Impact of Aortic Stiffness Evaluated by Aortic Pulsatility on Fractional Flow Reserve.

BACKGROUND: Fractional flow reserve (FFR) is a highly reproducible, accurate and lesion-specific index to indicate inducible ischemia for a particular coronary artery lesion. Invasively measured aortic pulsatility (AP) is an indicator of aortic stiffness. In this study we aimed to evaluate the possible impact of AP in terms of aortic stiffness on FFR measurement. METHODS: In this study, we reviewed the FFR evaluation of 90 patients who had intermediate lesions (40-70% stenosis measured with quantitative coronary analysis) at the left anterior descending artery (LAD). AP was calculated as the ratio of aortic pulse pressure (systolic-diastolic pressure) to mean pressure. RESULTS: Aortic systolic pressure, aortic diastolic pressure, aortic pulse pressure and also aortic pulsatility did not differ significantly between patients with FFR ≤ 0.80 and FFR > 0.80 (p = 0.44, p = 0.28, p = 0.93 and p = 0.41, respectively). In subgroups arranged according to the degree of luminal narrowing (40-50%, 51-60%, and 61-70%), we did not observe significant correlation between AP and FFR value in subgroups with 40-50% and 51-60% lesions (r = 0.03, p = 0.95 and r = 0.07, p = 0.69, respectively). However, a statistically significant negative correlation between FFR value and AP in the subgroup of patients with 61-70% lesions was detected (r = -0.54, p = 0.04). CONCLUSIONS: These findings suggested that aortic stiffness might have a possible impact on FFR measurement in coronary lesions of 61-70% stenosis evaluated quantitatively. KEY WORDS: Aortic pulsatility; Fractional flow reserve; Stiffness.

Impact of continuous positive airway pressure therapy on atrial electromechanical delay and P-wave dispersion in patients with obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) has been shown to be associated with atrial fibrillation (AF). Prolongation of inter- and intraatrial conduction times during sinus rhythm has also been shown to be related to AF generation. Nasal continuous positive airway pressure (CPAP) is an effective treatment modality of OSA. METHODS: Twenty-four OSA patients diagnosed through polysomnography and 18 controls were included in the study. The basal inter- and intraatrial electromechanic delays prior to onset of the therapy were measured using tissue Doppler imaging. P-wave dispersion (Pd) was calculated on the basis of 12-lead electrocardiography. Same measurements were performed in OSA patients 6 months after the initiation of the therapy. RESULTS: Interatrial (39.2 ± 8 vs. 21.1 ± 2.8 ms, P < 0.001), left intraatrial (20.5 ± 7.2 vs. 11.1 ± 2 ms, P = 0.003), and right intraatrial electromechanical delays (20.7 ± 11 vs. 10 ± 2.6 ms, P < 0.001) prior to CPAP therapy were found to be significantly greater in OSA group as compared with the controls. Pd was also greater in the OSA group as compared with the controls (44 ± 7 vs. 28.5 ± 4 ms, P < 0.001). However, significant improvement has been noted after 6 months of CPAP therapy in interatrial (P < 0.0001), left intraatrial (P = 0.002), and right intraatrial electromechanical delays (P < 0.0001) as well as in Pd (P < 0.0001) as compared to baseline values in patients with OSA. CONCLUSION: Our findings suggested that CPAP therapy provides more homogenous conduction through atria in patients with OSA. This effect may translate into decreased risk for AF associated with OSA.

Turkish Real Life Atrial Fibrillation in Clinical Practice: TRAFFIC Study.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. METHODS: The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. RESULTS: The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. CONCLUSION: The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

Mean platelet volume: an important predictor of coronary collateral development.

Collaterals, which develop in response to ischemic stimuli derived from coronary artery disease (CAD), contribute to reduction of infarct size, left ventricular dysfunction, and mortality. However, there is considerable variation among patients with coronary heart disease regarding the extent of coronary collateral development (CCD). In this study, we aimed to investigate the association of the degree of platelet activation via mean platelet volume (MPV) with coronary collateral circulation. Therefore, 210 patients who underwent coronary angiography and had coronary stenosis ≥50 % in at least one coronary artery were included in the study. Clinical information and analyses of blood samples were obtained from a review of the patients' chart. Blood samples for MPV were analyzed by K3 EDTA and collateral vessels were graded according to the Rentrop classification. In the study group, 150 of the 210 patients were found to have inadequate CCD. Although there was no difference between the two groups with regard to platelet count, MPV levels were significantly higher in the patients who had inadequate CCD (11.3 ± 1.0 fl vs. 9.5 ± 1.5 fl, p < 0.001). Furthermore, the Gensini score was significantly lower in patients who had inadequate CCD (45 ± 46 vs. 91 ± 35, p < 0.001). MPV, Gensini score, age, female gender, total cholesterol, red cell distribution width, triglyceride, and fasting glucose levels were found to have univariate association with poor CCD. In multivariate logistic regression model, MPV (OR = 2.45, p < 0.001) and Gensini score (OR = 0.98, p < 0.001) were found to be the independent predictors of impaired CCD. In receiver operator characteristic curve analysis, optimal cut-off value of MPV to predict inadequate CCD was found as >9.6 fl, with 96% sensitivity and 84.7% positive predictive value. In conclusion, we can say that MPV is an important, simple, effortless, and cost effective tool and can be useful in predicting the CCD in patients with significant CAD.

Impact of metabolic syndrome on fractional flow reserve.

OBJECTIVE: Fractional flow reserve (FFR) assessment is widely used to determine significance of intermediate coronary lesions. Previously, components of the metabolic syndrome (MS) which may affect FFR validity were not tested cumulatively. In this study, we investigate the possible effect of MS on FFR assessment. METHODS AND RESULTS: We retrospectively evaluated 178 consecutive patients who had undergone FFR assessment. Thirty-two patients were excluded. All of the coronary lesions were in the left anterior descending artery. They were evaluated with quantitative coronary angiography (QCA). In 105 patients the MS was present and 41 patients were without the MS. According to the severity of the coronary lesions in QCA, patients were divided into three groups: 40-50%, 51-60% and 61-70% lesions. FFR measurements were compared in each group with respect to MS presence. Coronary artery lesions were accepted as haemodynamically significant if FFR < or = 0.80. Age of the population, lesion length, lesion diameter and adenosine dosage performed during FFR assessment were not different between patients with MS or without MS. When the lesions were divided into three categories according to the severity of the luminal narrowing expressed in stenosis percentages as 40-50, 51-60, and more than 61%, the observed FFR values decreased with advancing lesion category (P = 0.04). However, observed FFR values did not differ between the patients with MS and without MS in each category (P = 0.88). After exclusion of the diabetic patients, FFR values still did not differ between the patients with MS and without MS in each category (P = 0.78). CONCLUSIONS: Presence of the metabolic syndrome has no significant effect on FFR assessment. This study provides additional data for the reliability of FFR in patients with MS.

[The prevalence of alternative herbal medicine and nutritional complementary product intake in patients admitted to out-patient cardiology departments]. / Kardiyoloji poliklinigine basvuran hastalarda bitkisel kökenli alternatif tedavilerin ve tamamlayici besin ürünlerinin tüketim prevalansi

OBJECTIVES: To detect the prevalence of alternative herbal medicine and nutritional complementary product intake in patients admitted to outpatient cardiology clinics and to determine demographic characteristics, comorbidities and medical properties of those patients. STUDY DESIGN: Patients admitted to outpatient cardiology clinics between June 2011 and March 2012 were given questionnaires involving age, gender, education, occupation, chronic illness, medication, herbs, nutritional complementary products, the index purpose and motivation for using herbs and nutritional complementary products. The data of those questionnaires were analyzed. RESULTS: A total of 454 questionnaires were collected. The mean age was 49±13 and 48% of the participants were female. Of those patients, 12% had diabetes, 34% had hypertension, 26% had coronary artery disease, 7% had heart failure, 58% had chronic illness, 49% had cardiovascular disease, and 57% had history of drug intake. Including vitamins and minerals, there were 75 (16%) patients taking alternative and complementary medicine. When vitamins and minerals were excluded, 56 (12%) patients were using at least one product, while 24 (5%) patients were using more than one. Garlic (n=33), flaxseed (n=13), ginger (n=12), omega 3 (n=12), and turmeric (n=11) were the most popular products. Of those 56 patients, 32% were using alternative medicine for hypertension and 23% for hyperlipidemia treatment, while 20% were using those products to be healthier in general. Alternative medicine was more prominent in females (p=0.04), and older patients (p=0.004). Education level, drug intake, and the presence of chronic illnesses, hypertension and cardiovascular disease were significantly higher in those patients. CONCLUSION: Alternative and complementary products were common in patients admitted to outpatient cardiology clinics. Female gender, advanced age, higher education level, drug intake, and having a chronic illness were predisposing factors.

[Mean platelet volume and the extent of coronary atherosclerosis in patients with stable coronary artery disease]. / Kararli anjinasi olan koroner arter hastalarinda ortalama trombosit hacmi ve koroner aterosklerozun yayginligi

OBJECTIVES: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain. STUDY DESIGN: A total of 540 patients (350 male, 190 female; mean age: 59.6±11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated. RESULTS: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5±0.1 fl, 8.5±1.2 fl, 8.6±0.9 fl and 8.6±0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values. CONCLUSION: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.

High ventricular lead impedance of a DDD pacemaker after cranial magnetic resonance imaging.

Management of electromagnetic interference in the form of magnetic resonance imaging (MRI) in patients with pacemakers (PMs) may be challenging. Serious consequences, especially in PM-dependent patients, may be encountered. Changes in device programming, asynchronous pacing, heating of the lead tip(s), and increased thresholds or even device dislocation may be experienced. We report of a patient with a DDD PM who underwent an emergent MRI, after which there was an increase in ventricular impedance as well as increased cardiac biomarkers.

Use of the mechanical dilator sheath for removal of endocardial leads: a single center experience.

BACKGROUND: Due to an increasing number of cardiac device implantations, the number of leads that need to be extracted because of infection or lead failure is consistently rising. We present our experience in percutaneous lead removal in a single tertiary center. METHODS: From December 2009 to August 2010, 12 patients underwent percutaneous lead extraction procedure by the Evolution™ mechanical dilator sheath (Cook Medical Inc., Bloomington, IN, USA) system after failure of manual traction and a locking stylet. RESULTS: Ages of the patients ranged between 7 and 86 years (mean age was 58 ± 12 years). Mean implantation time was 73 months (range between 12 and 244 months). Ten patients had one lead; only two patients had two leads. Indications for lead removal were: lead endocarditis in five patients, local (pocket) infection in four patients, and lead failure in three patients. All leads were successfully removed by using the device, except one lead which was one of the two leads in a patient with dual chamber pacemaker implanted 10 years ago. In three patients, same venous accesses (sheath of extraction system) were used to implant a new lead after removal of damaged leads without a new venous puncture. In only one patient, significant hematoma was found after the intervention and treated conservatively. No other significant complications were encountered in any patients. CONCLUSIONS: Damaged or infected leads can safely and relatively easily be extracted by using this new percutaneous extraction technique.