Mean platelet volume at admission is a determinant of left ventricular thrombus formation after primary percutaneous coronary intervention for first anterior wall myocardial infarction.

OBJECTIVE: Left ventricular thrombus (LVT) is one of the important complications of acute anterior wall myocardial infarction (MI). Mean platelet volume (MPV) is one of the platelet indices reflecting platelet reactivity. In this present study we investigated the effect of MPV on LVT formation after primary percutaneous coronary intervention (PPCI) for first anterior wall MI. METHODS AND RESULTS: A total of 205 acute anterior wall MI patients were included into this prospective observational study. Patients were divided into two groups according to the presence of LVT. The thrombus (-) group consisted of 161 patients and the thrombus (+) group of 44 patients. Complete blood count (CBC) parameters were measured at admission. Routine biochemical tests and echocardiographic examinations were performed. Groups are compared according to different parameters. With respect to CBC parameters: MPV (9.03 ± 0.76 vs 8.06 ± 0.83) was significantly higher in the thrombus (+) group, platelet count (184.09 ± 52.21 vs 219.88 ± 52.31) was significantly higher in the thrombus (-) group, WBC count (14.01 ± 4.43 vs 11.30 ± 3.53) was also significantly higher in the thrombus (+) group. Furthermore, peak troponin-T level (32.63 ± 20.18 vs 18.70 ± 23.82), CK-MB level at admission (133.49 ± 117.40 vs 71.79 ± 93.96), peak CK-MB level (245.47 ± 89.67 vs 167.37 ± 110.61) were significantly higher in the thrombus (+) group. Logistic regression analysis revealed that MPV was an independent risk factor of LVT formation. CONCLUSION: In acute anterior wall MI patients MPV is associated with the presence of LVT and is an independent risk factor of LVT formation.

Increased frequency of fragmented QRS in patients with severe aortic valve stenosis.

OBJECTIVE: To investigate the presence of myocardial fibrosis determined by fragmented QRS in patients with severe aortic valve stenosis. SUBJECTS AND METHODS: Eighty-seven consecutive patients with severe aortic valve stenosis and 83 age- and gender-matched control subjects were enrolled into this study. Severe aortic valve stenosis was defined as an aortic valve area <1 cm(2), a Vmax >4 m/s, or a mean gradient ≥40 mm Hg. Fragmented QRS was assessed using a 12-lead electrocardiogram. RESULTS: Fragmented QRS was detected in 40 (46%) patients in the aortic valve stenosis group and in 15 (18%) control subjects (p < 0.001). In multivariate binary logistic regression analysis, the presence of aortic valve stenosis was the only independent factor associated with fragmented QRS (OR = 3.69; 95% CI 1.81-7.55, p < 0.001). CONCLUSION: A higher frequency of fragmented QRS was detected in patients with severe aortic valve stenosis compared to controls.

The association between coronary atherosclerotic burden and asymmetric dimethylarginine, carotis intima media thickness and endothelial function.

OBJECTIVES: Detection of extent and severity of atherosclerosis using easy, non-invasive methods is of great importance. Atherosclerotic burden may be evaluated with the Gensini scoring system (GSS). Carotis intima media thickness (CIMT), plasma asymmetric dimethyl arginine (ADMA) level, and endothelial dysfunction are well known surrogate markers of atherosclerosis. The aim of this study was to evaluate the relationship between atherosclerotic burden determined by the GSS, and ADMA, CIMT and endothelial function. STUDY DESIGN: Consecutive patients who had undergone coronary angiography were evaluated. 50 patients with acute coronary syndrome (ACS), 50 patients with stable coronary artery disease (SCA), and 50 patients with normal coronary arteries (NCA) were included. All subjects' GSS, ADMA, CIMT and endothelial functions were evaluated and compared. RESULTS: GSS was higher in ACS than SCA (75.4 vs 54.9; p<0.001). CIMT was higher in ACS and SCA in compared to NCA (0.98, 0.96, 0.78 mm respectively; p<0.001). Endothelium derived vasodilatory response (EDVR) was decreased in ACS and SCA in compared to NCA (3.5±2.1%, 3.3±1.8%, 7.2±3.5% respectively; p<0.001). Plasma ADMA concentration was higher in ACS and SCA in compared to NCA (0.928, 0.992, 0.475 µmol/l respectively; p<0.001). There was a weak positive correlation between GSS and plasma ADMA levels (r=0.293; p=0.002), an intermediate positive correlation between GSS and CIMT (r=0.508; p<0.001), and an intermediate negative correlations between GSS and EDVR (r= -0.662; p<0.001). CONCLUSION: This study showed that CIMT, ADMA concentration and endothelial dysfunction were significantly associated with CAD. However, only the GSS was significantly different between ACS and SCA groups.

Coronary artery calcification score is increased in patients with isolated coronary artery ectasia.

PURPOSE: Coronary artery calcification (CAC) is an indicator of coronary atherosclerosis and is associated with future adverse cardiac events. Isolated coronary artery ectasia (CAE) is defined as localized or diffuse dilation of the coronary arteries without coronary stenosis. The aim of this study was to assess the relationship between CAC and isolated CAE. METHODS: Thirty-four patients with isolated CAE and 50 controls subjects, with normal coronary arteries, were enrolled in the study. Baseline demographic features and atherosclerosis risk factors were similar in both groups. RESULTS: Patients with CAE had higher total CAC than control subjects (84±111 vs. 33.5±103.5; p<0.001). There was also a significant correlation between per-segment CAC and ectatic segment length (r=0.32; p=0.01) but no correlation with diameter (r=0.09; p=0.5). CONCLUSION: Patients with isolated CAE had higher CAC than control subjects, suggesting that atherosclerosis may be involved in the pathogenesis of isolated CAE. Patients with isolated CAE may have increased cardiovascular risk and should receive appropriate risk stratification and relevant medical treatment.

Association between diagonal earlobe crease and cardio-ankle vascular index in asymptomatic hypertensive patients.

OBJECTIVE: The aim of this study was to investigate the association between earlobe crease (ELC) and cardio-ankle vascular index (CAVI) in asymptomatic hypertensive subjects. MATERIALS AND METHODS: A total of 75 subjects with ELC and 75 age- and gender-matched patients without ELC were prospectively selected from subjects admitted to the Outpatient Cardiology Clinic. ELC was assigned to a person with a crease stretching obliquely from the outer ear canal towards the border of the earlobe of at least one ear. CAVI was assessed by a VaSera VS-1000 instrument. RESULTS: There were statistically significant higher CAVI values in ELC subjects (9.8 ± 2.1 vs. 8.6 ± 1.6, p < 0.001). There was a significant and positive association between CAVI and age (r = 0.42, p < 0.001), ELC (r = 0.31, p < 0.001), BMI (0.20, p < 0.001) and male gender (r = 0.21, p = 0.04). Linear regression analysis demonstrated ELC (95% confidence interval, CI, 0.61-1.74, p = 0.009), age (95% CI 0.03-0.09, p < 0.001) and male gender (95% CI 0.48-1.55, p = 0.03) as independent determinants of CAVI. Also, there was a higher prevalence of ELC in subjects with subclinical atherosclerosis (CAVI ≥9) than in normal subjects (CAVI <9). CONCLUSION: Patients with ELC had higher CAVI than normal subjects. This observation of ELC is simple, adds no cost and can be easily made by most physicians, and it may provide important predictive information of arterial stiffness and subclinical atherosclerosis in asymptomatic hypertensive subjects. © 2013 S. Karger AG, Basel.

Epicardial adipose tissue increased in patients with newly diagnosed subclinical hypothyroidism.

OBJECTIVE: To investigate whether or not patients with subclinical hypothyroidism (SH) have increased epicardial adipose tissue (EAT). SUBJECTS AND METHODS: Sixty-one patients with newly diagnosed SH and without any known cardiovascular disease were enrolled. Twenty-four subjects matched for age, gender and body mass index without any thyroid dysfunctions were included as a control group. The EAT was measured by echocardiography and thyroid functions were assessed by routine blood examination. RESULTS: Patients with SH had higher EAT values than control subjects (3.6 ± 0.9 vs. 2.8 ± 1.4, p = 0.005). Also, SH patients with thyroid-stimulating hormone (TSH) ≥10 mU/l had higher EAT than those with SH with TSH <10 mU/l and control subjects (p = 0.013). In addition, while there was significant correlation between EAT and TSH (r = 0.31, p = 0.014) in patients with SH, there was no significant relation between EAT and TSH in normal subjects (r = 0.09, p = 0.64). CONCLUSIONS: There was a higher level of EAT in patients with SH compared with normal subjects and a significant correlation between EAT and TSH was found.

Relationship between Duke Treadmill Score and coronary artery lesion complexity.

PURPOSE: The purpose of this study was to investigate the relationship between the Duke Treadmil Score (DTS) and coronary artery disease (CAD) complexity in patients with suspected coronary artery disease (CAD). METHODS: Sixty five patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed and Syntax score (SxScore), a marker of CAD complexity, was determined. The relationship between DTC and SxScore then evaluated. RESULTS: There was a strong negative correlation between DTS and SxScore (r = - 0.91, p < 0.001). In addition, patients with higher and intermediate risk as evaluated by DTS had increased SxScore compare to those that were low risk (23 ± 6, 6 ± 5 and 0 ± 0 respectively). CONCLUSIONS: A strong negative correlation was seen between DTS and coronary lesion complexity. By assessing DTS important information about coronary artery lesion complexity can be obtained before invasive coronary angiography.

Evaluation of right ventricular function in early period following transcatheter closure of atrial septal defect.

AIMS: There is limited data on alterations in novel right ventricular (RV) function indices like tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV) after transcatheter atrial septal defect (ASD) closure. We aimed to evaluate RV function by echocardiography (ECG) with these novel indices in early period in patients with secundum-type ASD that was closed percutaneously. METHODS: Patients were enrolled to study if they had secundum-type ASD that was suitable for percutaneous closure. Patient population consisted of 4 men and 16 women. Echocardiography was performed before and 1 month after closure. RESULTS: Mean age was 37 ± 16. Mean diameter of ASD and total atrial septum length measured by ECG were 19 ± 6 mm and 49 ± 7 mm, respectively. Mean diameter of defect in transesophageal echocardiography was 20 ± 6 mm. Stretched mean diameter in catheterization was 23 ± 6 mm. One month after closure, there were statistically significant decreases in RV end-diastolic diameters (43.3 ± 10.7 mm vs. 34.9 ± 5.5 mm; P < 0.001), RV/left ventricular (LV) end-diastolic diameter ratio (1.1 ± 0.3 vs. 0.87 ± 0.1; P < 0.001), TASV (16.9 ± 3.2 cm/sec vs. 14.3 ± 3.3 cm/sec; P < 0.05), early diastolic tricuspid annular velocity (15.3 ± 3.1 cm/sec vs. 13.4 ± 2.4 cm/sec P <0.05), late diastolic tricuspid annular velocity (16.2 ± 5.4 cm/sec vs. 14.3 ± 6.3 cm/sec; P < 0.05), and TAPSE (29.9 ± 6.2 mm vs. 22.4 ± 7.4 mm; P < 0.001). LV end-diastolic diameter (38.0 ± 6.9 mm and 40.0 ± 4.5 P < 0.05) was increased, whereas there was no change in LV ejection fraction. CONCLUSION: Closure of ASD by using Amplatzer devices led to decrease in right heart chamber size, tissue Doppler-derived tricuspid annular velocities and TAPSE in early period.

Changes in serum natriuretic peptide levels after percutaneous closure of small to moderate ventricular septal defects.

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3 ± 14.3) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3 ± 78.6 versus 26.8 ± 15.6, P = 0.013). Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.

Aortic knob calcification and coronary artery lesion complexity in non-ST-segment elevation acute coronary syndrome patients.

OBJECTIVES: Coronary artery lesion complexity is important for risk stratification of acute coronary syndrome (ACS) patients undergoing cardiac catheterization. SYNTAX score is a pure angiographic measure of anatomic coronary complexity. Chest radiography is a routine examination for evaluating patients with chest pain. There have been no studies to date exploring the relation between aortic knob calcification (AKC) and coronary lesion complexity assessed by SYNTAX score. STUDY DESIGN: 135 consecutive patients with first time diagnosis of non-ST segment elevation ACS were enrolled. SYNTAX score was calculated by dedicated computer software. Aortic calcification was assessed visually. RESULTS: Patients with AKC had higher SYNTAX score compared to those without AKC (16±6 vs. 11±7, p=0.019). Also, patients with AKC had higher TIMI risk score and were more elderly. Linear regression analysis demonstrated AKC (95% confidence interval [CI] 1.7-6.9, p=0.002), diabetes (95% CI, 1.1-5.7, p=0.005), and smoking (95% CI, 1.2-13.5, p=0.004) as independent determinants of SYNTAX score. CONCLUSION: Aortic calcification detected on chest X-ray is an independent predictor of complex coronary artery lesions in patients with ACS.

Increased leucocyte count could predict coronary artery calcification in patients free of clinically apparent cardiovascular disease.

OBJECTIVES: Several studies have demonstrated that inflammation plays a major role in the development of atherosclerosis and that the inflammatory process might also be involved in coronary artery calcification (CAC). The main purpose of this study was to investigate the relation between leucocyte count and CAC and to determine whether a higher leucocyte count could indicate subclinical atherosclerosis in patients without overt cardiovascular disease. STUDY DESIGN: A total of 284 consecutive patients (156 men, 128 women) without established cardiovascular disease were enrolled. CAC was measured using cardiac computed tomography. Leucocyte count was measured via routine blood examination. RESULTS: Patients with CAC had higher leucocyte counts compared to those without calcification (7.87±1.85 vs. 6.01±1.84; p<0.001). Logistic regression analysis identified the following as independent predictors of CAC: leucocyte count (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3-2.1), smoking (OR: 2.4, 95% CI: 1.2-4.6) and age (OR: 1.2, 95% CI: 1.1-2.3). There was also a significant correlation between CAC and leucocyte count (r=0.57, p<0.001). CONCLUSION: We demonstrated that leucocytes may play an important role in the evolution of CAC and may be used in the detection of subclinical atherosclerosis in asymptomatic subjects.

Aortic coarctation: angioplasty and stenting of a total occlusion.

A 23-year-old man presented with dyspnoea and a blood pressure of 180/120 mmHg in both arms. Femoral and popliteal pulses were absent and there was a systolic ejection murmur along the left intercostal area.The chest X-ray showed rib notching and a normal cardiac silhouette.Transthoracic echocardiography showed a bicuspid aortic valve with a mild degree of left ventricular dysfunction and an interruption of the aorta 3 cm distally of the left subclavian artery. A 64-slice CT angiography confirmed an interruption with extensive collateral circulation. Angioplasty and implantation of a covered stent were successful. Six months after the procedure, the patient is asymptomatic and without any complication.

Short- and mid-term effects of covered stent implantation on extremity findings and heart failure in Parkes Weber syndrome: a case report.

BACKGROUND: Parkes Weber syndrome (PWS) is a congenital disease characterized by vascular malformations, such as arteriovenous fistulas (AVFs). It frequently presents with overgrowth of a lower limb and high-output heart failure. The main treatment is to close vascular malformations. Surgical excision or endovascular coil insertion was performed in a few patients with AVFs. However, vascular covered stent implantation has not been used for treating PWS. CASE SUMMARY: A 15-year-old male patient with PWS presented to our hospital because of dyspnoea and massive left upper limb swelling. After initial examination and left upper limb angiography, his symptoms and findings were attributed to the presence of high-flow large AVFs despite the presence of many coils previously inserted. We decided to implant a covered stent along the AVFs between the subclavian and axillary arteries. After stent implantation, the patient's complaints and findings improved during the early term but they relapsed at the 6th month after percutaneous intervention. DISCUSSION: Here, we report for the first time the use of covered stent implantation and its short and 6 months results in a patient with PWS. Although initial improvements were noted, the clinical outcome at 6 months after stent implantation was poor. This was probably associated with the presence of widespread subtle AVFs or collateral connections among the existing AVFs. Based on our result, we propose that closure of large AVFs is not useful and more definitive interventions, such as limb amputation may be required earlier.

Blood cyst of tricuspid valve: an incidental finding in a patient with ventricular septal defect.

Blood-filled cysts of heart valves are rare in adults. These cysts are diverticuli lined by endothelium and filled with blood. They appear to be benign lesions and should be removed if they cause problems. We present the case of a mobile tricuspid valve blood cyst that was incidentally found in a patient evaluated for systolic heart murmur. Systolic murmur was found to originate from a muscular-type ventricular septal defect of no haemodynamic significance. The lack of echocardiographic evidence of tricuspid valvular dysfunction and indication for repair of co-existent ventricular septal defect suggested a benign course and, therefore, we monitored the patient safely by echocardiography.

The effect of glucose-insulin-potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention.

OBJECTIVES: In this study, we sought to examine the effect of glucose-insulin-potassium (GIK) treatment on oxidative stress in patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary interventions (PCIs). METHODS: Patients with ACSs who had been electively treated with a stent implantation into the culprit vessel were included in this study. Patients were divided into two groups and were randomly administered either the GIK treatment (GIK group; n=28) or isotonic NaCl (control group; n=19) infusion during PCI. Blood samples from the coronary artery ostium (CO) were collected through the femoral artery and from the coronary sinus (CS) through the femoral vein, before and immediately after PCI. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured. RESULTS: A total of 47 patients were included in the study. SOD, CAT, and GSH-Px activities, whether in the CO or the CS, were similar in both the GIK and control groups before the intervention (P>0.05). In the control group, SOD (in both the CO and the CS), CAT (in the CS), and GSH-Px (in the CS) activities were higher compared with baseline values (P<0.05). Such increases were, however, not seen in the GIK group (P>0.05). Although the CS-CO activity differences (venous-arterial) of SOD, CAT, and GSH-Px, which are parameters of myocardial reactive antioxidant enzyme production, were increased in the control group, there was no increase in the GIK group. CONCLUSIONS: In patients with ACSs, reactive local enzyme activity increases for the scavenging to myocardial-free radicals during PCI. Administration of a solution of GIK as a metabolic support agent might prevent oxidative stress in the myocardial level, in these patients.

Diagonal earlobe crease associated with increased epicardial adipose tissue and carotid intima media thickness in subjects free of clinical cardiovascular disease.

OBJECTIVE: Atherosclerotic coronary artery disease is a leading cause of death, worldwide. Diagonal earlobe crease (DELC) has been suggested as a simple, noninvasive marker of cardiovascular disease. Although epicardial adipose tissue (EAT) thickness and carotid intima media thickness (CIMT) are closely related to atherosclerosis, the relation between EAT, CIMT, and DELC had yet to be studied. The present objective was to analyze this association. METHODS: Subjects were apparently healthy individuals referred to the cardiology outpatient clinic. A total of 65 subjects with DELC and 65 age- and sex-matched controls without DELC were enrolled. EAT thickness and CIMT were measured and analyzed. RESULTS: Epicardial adipose tissue thickness was significantly higher in the DELC group (0.57±0.12 vs. 0.35±0.05; p<0.0001). CIMT was also significantly higher in DELC group (0.85±0.16 vs. 0.60±0.15; p<0.0001). Correlation analysis showed that CIMT was significantly correlated with EAT thickness (r: 0.594; p<0.0001). Linear regression analysis showed that presence of DELC was independently associated with CIMT and EAT thickness. CONCLUSION: A significant and independent association between the presence of DELC and increased CIMT and EAT thickness was presently determined, for the first time, in subjects free of clinical cardiovascular disease.