Can HALP score predict post-contrast acute kidney injury and 6-year mortality in patients undergoing endovascular abdominal aneurysm repair?

BACKGROUND: The aim of this study is to investigate the relationship between HALP score and post-contrast acute kidney injury (PC-AKI) and average 6-year mortality in patients undergoing endovascular abdominal aortic aneurysm repair (EVAR). METHODS: 125 patients who underwent EVAR between January 2015 and December 2020 were included in our study. HALP score was calculated with the formula "hemoglobin × albumin × lymphocyte count/platelet count." In the first phase of the study, two groups were developed: those who developed PC-AKI and those who did not. In the second stage, statistical analysis was performed by creating two groups: average 6-year mortality and survivors group. RESULTS: HALP score was found to be lower in the PC-AKI group [26.12 (14-61.54) versus 40.53 (7.22-103.61); p < .001]. Low HALP score was found to be both a dependent and independent predictor of the development of PC-AKI (p = .019). HALP score was also found to be lower in the mortality group compared to the survivors [28.97 (12.6-103.61) versus 40.81 (7.22-99) p = .004]. Low HALP score was found to be only a dependent predictor of mortality. The development of PC-AKI was found to be an independent predictor of mortality (p = .042). CONCLUSIONS: The HALP score, which can be calculated with a simple formula, can be used to predict PC-AKI and medium-long-term mortality in EVAR patients.

Relation of p - wave dispersion with presystolic a - wave and aortic valve sclerosis in asymptomatic subjects.

BACKGROUND: P-wave duration and P-wave dispersion (PWD) are thought to be the surrogate marker of devoloping atrial fibrillation (AF). The main purpose of present study was to investigate the association between presystolic wave (PSW), aortic valve sclerosis, and PWD. PATIENTS AND METHODS: Patients with sinus rhythm admitted to the cardiology outpatient clinic were consecutively enrolled. Maximum (Pmax) and minimum (Pmin) P-wave duration and PWD were measured. Echocardiography was used to assess the aortic valve morphology and presence of PSW. The patients were divided into two groups according to presence or absence of AVSc and PSW. RESULTS: A total of 100 patients were enrolled consecutively. Patients with both PSW and AVSc had higher PWD values compared with those without PSW (42 ± 15 vs 65 ± 20) and AVSc (52 ± 21 vs 69 ± 19). The patients were categorized on the basis of median PWD values. According to univariate analysis, there was significant association between PWD and presence of PSW (P: .004), presence of AVS (P: .011), hypertension (P: .01) interventricular septal thickness (IVST) (P: .026), and posterior wall thickness (PWT) (P: .022). Multivariate logistic regression analyses demonstrated presence of PSW (95% confidence interval (1.058-6.505, P: .037) as an independent determinant of PWD. CONCLUSION: Assessment of presystolic A-wave on echocardiography examination may provide important information regarding the atrial conduction velocities that is a electrophysiological cause of AF. While there was a significant association between AVSc and PWD in univariate analysis, this significance disappeared in multivariate analysis.

Relation between fragmented QRS complex and cardio-ankle vascular index in asymptomatic subjects.

OBJECTIVES: Stiffness of large arteries has been related to cardiovascular mortality. Cardio-ankle vascular index (CAVI) is a novel marker of arterial stiffness. Herein, we aimed to study the relationship between fragmented QRS (fQRS) in electrocardiogram and CAVI. METHODS: Asymptomatic patients with fQRS and without fQRS were enrolled in the study consecutively. The fQRS complexes were analyzed in the 12-lead electrocardiogram. Arterial stiffness was assessed by using cardio ankle vascular index (CAVI). It was measured by a VaSera VS-1000 CAVI instrument. RESULTS: CAVI values of the patients with fQRS was significantly higher compared to those without fQRS (8.625 (7.9-9.2) versus 6.65 (6.7-8.4) p < .001). In a univariate analysis, it was revealed that there was a significant correlation between increased CAVI and fQRS, age, and epicardial fat thickness. Multiple binary logistic regression analysis revealed that age [95% confidence interval (CI): 1,068-1.214, p < .001] and fQRS [95% (CI): 1.766-23.117, p: 0.005] were the independent determinants of increased CAVI values. CONCLUSIONS: ECG is a widely and readily available, inexpensive, reproducible technique that can be examined by almost every physician. fQRS values in electrocardiogram may provide a significant predictive value for arterial stiffness in asymptomatic subjects.

Xanthelasma Is Associated with an Increased Amount of Epicardial Adipose Tissue.

OBJECTIVE: In the present study, we aimed to compare the amount of epicardial adipose tissue in subjects with and without xanthelasma. SUBJECTS AND METHODS: Fifty-two subjects with xanthelasma and 52 age- and gender-matched control subjects were enrolled in this study. Epicardial adipose tissue was assessed by measuring epicardial fat thickness (EFT) with echocardiography. Participants were dichotomized according to median EFT, which was 4 mm. The group with EFT >4 mm was defined as the supramedian group. Body mass index (BMI) was calculated by weight (kilograms) divided by height (meters) squared. Conditional logistic regression analysis was performed to find independent factors associated with supramedian EFT (>4 mm). RESULTS: Subjects with xanthelasma had higher BMI (31.2 ± 5.6 vs. 28.6 ± 5.7, p = 0.01) and higher levels of total cholesterol (216 ± 54 vs. 181 ± 42 mg/dl, p < 0.001), LDL cholesterol (142 ± 45 vs. 115 ± 36 mg/dl, p = 0.003) and triglycerides (median, 154 vs. 101 mg/dl, p = 0.01) than control subjects. EFT was significantly higher in subjects with xanthelasma than in controls (5.04 ± 2.02 vs. 3.81 ± 2.03 mm, p = 0.002). In the conditional logistic regression analysis, the presence of xanthelasma (OR, 3.55; 95% CI, 1.43-8.78, p = 0.006) and lower HDL cholesterol level (OR, 0.96; 95% CI, 0.92-0.99, p = 0.023) were independently associated with supramedian EFT. CONCLUSION: The amount of epicardial adipose tissue found in subjects with xanthelasma was higher than in subjects without xanthelasma. In addition, the presence of xanthelasma was independently associated with supramedian EFT.

Echocardiographic Evaluation of Biventricular Function in Patients with Euthyroid Hashimoto's Thyroiditis.

OBJECTIVE: The aim of this study was to evaluate the left (LV) and right (RV) ventricular function in euthyroid Hashimoto's thyroiditis (eHT) patients. SUBJECTS AND METHODS: Forty-five patients diagnosed with eHT and 45 age- and gender-matched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities (E, A, E', A'), isovolumic relaxation (IVRT) and contraction (IVCT) times, ejection time (ET), deceleration time (DT), Tei index, pulmonary acceleration time (PAcT) and tricuspid annular plane systolic excursion (TAPSE) of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signed-rank test. RESULTS: Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index (0.6 ± 0.2 vs. 0.4 ± 0.1, p < 0.001), higher DT (p < 0.001) and IVRT (p < 0.001) values, and higher E/E' ratios (p = 0.04). In contrast, the peak E wave velocity (p = 0.02), E/A ratio (p = 0.01) and ET (p = 0.02) were significantly lower in the eHT group than amongst the controls. The RV, Tei index (0.40 ± 0.11 vs. 0.28 ± 0.07, p < 0.001), TAPSE (2.0 ± 0.3 vs. 2.2 ± 0.2 mm, p < 0.001), PAcT (124.3 ± 22.6 vs. 149.4 ± 18.3 ms, p < 0.001), A' (p = 0.007) and IVCT (p = 0.001) were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio (p = 0.01), E' (p = 0.03) and E'/A' ratio (p = 0.001) were significantly lower in the eHT patients than the control group. CONCLUSIONS: This study demonstrated that both RV and LV functions were impaired in patients with eHT.

Transcatheter aortic valve implantation in a patient with myelofibrosis and severe thrombocytopenia.

Transcatheter aortic valve implantation (TAVI) has been commonly used to treat patients with aortic stenosis who have a contraindication to, or a high risk of, corrective surgery. Anti-thrombotic treatment is an important part of the TAVI procedure to avoid thrombotic complications during both peri- and post-procedural periods. However, no specific data are available regarding the safety of TAVI with or without anti-thrombotic treatment, either during the surgical procedure or follow up period in patients with thrombocytopenia, such as myelofibrosis. Here, the case is reported of a patient with myelofibrosis and severe thrombocytopenia who underwent a TAVI procedure without anti-thrombotic treatment such as heparin, acetyl salicylic acid, or clopidogrel.

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.

Relationship between Nitrate-Induced Headache and Coronary Artery Lesion Complexity.

OBJECTIVE: The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). SUBJECTS AND METHODS: Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. RESULTS: The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore. CONCLUSION: The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD.

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.

A simple angiographic index to predict adverse clinical outcome associated with acute myocardial infarction.

OBJECTIVES: The major determinant of final infarct size for a given coronary occlusion is the size of the myocardial area-at-risk. We propose herein a new index 'Relative Importance Index (RII)' to predict area-at-risk in patients with anterior myocardial infarction (MI). The aim of the study was to assess the predictive value of RII in left ventricle (LV) systolic function reduction and its relation to adverse clinical outcome. STUDY DESIGN: One hundred twenty-three acute anterior MI patients with their first acute coronary syndrome incident were consecutively and prospectively enrolled in to the study. RII was calculated by dividing the culprit segment diameter by the sum of diameters of the left anterior descending, circumflex, and right coronary arteries at their proximal segments. We evaluated the one-month follow-up rates of major clinical endpoints, which were defined as death, non-fatal MI, stroke, and new congestive heart failure (CHF). RESULTS: RII was significantly and negatively correlated with left ventricular ejection fraction (LVEF) (r=-0.65, p<0.001). Likewise, RII was significantly correlated with 72 hour troponin I (TnI) (r=0.48, p<0.001). Patients were dichotomized according to the median value of RII (median RII: 0.30). Supra-median RII was associated with lower EF (32.8±8.6 vs. 42.8±9.4, p<0.001) and higher incidence of composite major adverse cardiac events (33.9% vs. 13.1%, p=0.01). The mortality, non-fatal MI and new CHF rates in the supra-median RII group trended higher but they did not reach statistical significance. An RII >0.30 had an 88% sensitivity and 60% specificity (ROC area: 0.82, p<0.001, CI: 0.73-0.90) for predicting severe LV dysfunction (LVEF<30%). CONCLUSION: A simple index derived from coronary angiography at the time of primary percutaneous coronary intervention can predict LV systolic function loss and adverse clinical outcome in patients with acute anterior MI.

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.

Is coronary artery disease complexity valuable in the prediction of contrast induced nephropathy besides Mehran risk score, in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention?

BACKGROUND: The association of coronary artery disease complexity with contrast induced nephropathy (CIN) in patients with acute ST segment elevation myocardial infarction (STEMI) is inadequately evaluated and to our knowledge the association between SYNTAX score (SS) and Mehran score (MS) have not been studied. The aim of the present study is to clarify the incidence of CIN and to identify demographic, clinical and procedural variables associated with CIN in patients who underwent primary percutaneous coronary intervention (PPCI) due to acute STEMI, besides the association between MS and SS with CIN. METHODS: We analysed the clinical data of 402 patients (309 male, 93 female, mean age 63.8 ± 12.65 year) with 179 (44.5%) anterior MI, 104 (25.9%) inferior MI, 119 (29.6%) inferior MI with right ventricular involvement who underwent PPCI. RESULTS: We found that CIN was observed in 32.6% of patients. The SS (OR=1.037, %95CI=1.012-1.062, p=0.003), MS (OR=1.072, %95CI=1.025-1.121, p=0.003), HDL (OR=0.974, %95CI=0.949-0.999, p=0.044) were the independent predictors of CIN. The cut off value to show CIN for SS was 31.5 (sensitivity=79.4%, specificity=88.6%) and MS was 12.5 (sensitivity=73.3%, specificity=88.9%) in ROC curve analysis. CONCLUSION: In conclusion, besides MS, SS may be a valuable marker to identify patients at high risk for CIN in patients undergoing primary percutaneous intervention.

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.

Inflammatory Profile in Left Ventricular Apical Thrombus.

OBJECTIVE: To investigate the relationship between systemic immune inflammation index (SII), C-reactive protein/albumin ratio (CAR), lymphocyte/CRP ratio (LCR), and apical thrombus development. STUDY DESIGN: Observational, cross-sectional study. Place and Duration of the Study: Bursa City Hospital, Turkey, from 1st January to 31st March 2023. METHODOLOGY: Twenty-two patients with a clinical presentation of acute anterior myocardial infarction and diagnosed with LVAT during follow-up were included. Sixty-eight patients with acute anterior myocardial infarction (AMI) were selected as the control group (comparison). Clinical and demographic characteristics, laboratory data, echocardiographic findings, coronary angiography, and percutaneous coronary intervention data were recorded. SII was calculated by the formula Neutrophil (N) × Platelet (P) / Lymphocyte (L). CAR and LCR values were also determined. RESULTS: While there was no significant difference between the two groups in terms of SII, CAR was significantly higher and LCR was significantly lower in the apical thrombus group. The cut-off value for CAR was 0.165 (sensitivity=63.64%, specificity=74.60%, AUC=0.718; p <0.05). For LCR, the AUC value of 0.382 and below was found to indicate the presence of apical thrombus with a probability of 69.8% (sensitivity=68.18%, specificity=67.16%, p= 0.002). CONCLUSION: No significant relationship was found between SII and apical thrombus in the detection of LVAT, whereas high CAR and low LCR were associated with the presence of apical thrombus. KEY WORDS: Left ventricular apical thrombus, Apical aneurysm, C-reactive protein/albumin ratio, Lymphocyte/C-reactive protein ratio, Systemic immune inflammation index.

The Systemic Immune-Inflammation Index Predicts Impaired Myocardial Perfusion and Short-Term Mortality in ST-Segment Elevation Myocardial Infarction Patients.

In this study, we aimed to evaluate the utility of the immune-inflammation index (SII) in estimating the no-reflow phenomenon and short-term cardiovascular prognosis in patients with ST-segment elevation myocardial infarction (STEMI). 723 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled in our study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. The multivariate regression analysis analyzed the correlation between no-reflow and SII. The median value of SII was significantly higher in patients with no-reflow in comparison with normal reperfusion [1466 (939-2409) vs 905 (566-1379), p < .001]. The optimal threshold for SII in predicting the no-reflow phenomenon was 1036, with sensitivity and specificity of 70% and 59%, respectively. The area under the ROC curve (AUC) was 0.71 (95% CI, 0.66-0.75, p < .001). In multivariate analysis, SII ≥ 1036 value showed an independent predictive value for the no-reflow (OR = 0.51, 95% CI: 0.29-0.92, p = .02) and the 30-day cardiovascular mortality (OR = 2.37, 95% CI: 1.34-4.19, p = .003). Our results suggest that higher SII levels are independently associated with the no-reflow phenomenon and 30-day mortality in STEMI patients undergoing primary PCI.

Effect of Sarcopenia on Coronary Atherosclerotic Burden, Lesion Complexity, and Major Cardiovascular Events in Elderly Patients With Acute Coronary Syndrome: A 1-year Follow-up Study.

Sarcopenia is accepted as an indicator of subclinical atherosclerosis. However, its effects on clinical coronary atherosclerotic burden and lesion complexity and major adverse cardiovascular events (MACE) in elderly patients with non-ST elevation myocardial infarction (NSTEMI) are unknown. Therefore, we evaluated these possible effects. Coronary artery disease (CAD) burden and complexity were assessed using the Gensini and TAXus and cardiac surgery (SYNTAX) score, respectively. MACE involving nonfatal myocardial infarction, rehospitalization, ischemic stroke, and total mortality were evaluated after 1 year of the index NSTEMI event. The study included 240 elderly patients; of these, 60 (25%) patients had sarcopenia. The SYNTAX score and Gensini score were similar in both groups (16.8 ± 8.7 vs 17.3 ± 9.2, P = .63 and 67.7 ± 43.9 vs 73.9 ± 45.5, P = .31, respectively). The total MACE rate was significantly higher in patients with sarcopenia than in those without sarcopenia (31.7 vs 14.4%, P = .003). In the multivariate model, age [odds ratio (OR) 1.112, 95% CI: 1.006-1.228, P = .04)], ejection fraction (OR: .923, 95% CI: .897-.951, P < .001), and sarcopenia (OR: 2.262, 95% CI: 1.039-4.924, P = .04) were independently associated with MACE. Sarcopenia was independently associated with MACE but not with CAD burden or complexity in elderly patients with NSTEMI.

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.

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.