Fragmented QRS Is Associated with Improved Predictive Value of Exercise Treadmill Testing in Patients with Intermediate Pretest Likelihood of Significant Coronary Artery Disease.

BACKGROUND: The predictive value of exercise treadmill testing (ETT) remains inadequate in diagnosing patients with suspected coronary artery disease (CAD) and needs to be improved. OBJECTIVE: The aim of this study was to investigate whether the presence of FQRS on 12-lead ECG would increase the PPV of ETT in patients with an intermediate likelihood of CAD. METHODS: fQRS, defined as the presence of notched R or S waves without accompanying typical bundle branch block or the existence of an additional wave-like RSR' pattern in the original QRS complex (with a duration of <120 ms), was assessed in 95 patients with positive ETT. Coronary angiogram (CA) was performed in all patients, divided into two groups as the significant CAD group and nonsignificant CAD group according to coronary artery lesions. The differences between the groups in terms of the presence of fQRS and clinical characteristics were investigated. RESULTS: The mean age of patients was 51.3 ± 11.3 years, and 74 of them were males (77.9%). FQRS was present in 47 (49.5%) patients, and significant CAD was demonstrated in 51 subjects (53.7%) among the enrolled subjects. fQRS was more prevalent in the significant CAD group compared to nonsignificant CAD group (P < 0.001). The presence of FQRS increased the PPV of positive ETT from 53.7% to 85.1%. In addition, FQRS was associated with the increased risk of significant CAD in multivariate analysis (OR = 2.839, P < 0.001). CONCLUSION: In clinical practice, the presence of fQRS in patients with positive ETT may support clinicians during the decision-making process with regard to the referral for a coronary angiography.

Serum prolidase activity in patients with left ventricular diastolic dysfunction.

OBJECTIVES: Prolidase is an important factor in collagen metabolism, matrix remodelling and cell growth. Increased collagen turnover leading to increased ventricular stiffness plays an important role in the pathophysiology of left ventricular diastolic dysfunction (LVDD). This study aims to investigate whether serum prolidase activity is related to left ventricular diastolic function. METHODS: We studied 144 participants, and divided them into four groups according to the phase of diastolic dysfunction (66 with normal function, 46 with impaired relaxation, 19 with pseudonormalization, and 13 with restrictive-like filling). Assessment of diastolic filling was carried out with the measurements of E wave, A wave, E-wave deceleration time, isovolumic relaxation time, lateral tissue Doppler E S, E and A wave. Serum prolidase activity was measured by spectrophotometrical methods. RESULTS: Serum prolidase activity level was higher in patients with left ventricular diastolic dysfunction (LVDD) than without LVDD (P = 0.004). Also, prolidase activity values gradually increased from stage I through stage III in patients with LVDD. Multivariate analysis shows that LVDD is independently associated with age (ß = 0.066, SE = 0.017, P = 0.006), hypertension (ß = -1.252, SE = 0.354, P = 0.037) and prolidase activity (ß = 0.021, SE= 0.088, P= 0.045). CONCLUSION: Our data have shown that, in a selected group of patients, serum prolidase activity was positively and independently associated with the presence and severity of LVDD.

Serum paraoxonase-1 activity in children: the effects of obesity and insulin resistance.

Oxidative stress (OS) is important in the pathogenesis of atherosclerosis. Paraoxonase-1 (PON1) is an enzyme found in the circulation associated with high-density lipoprotein (HDL). HDL-associated enzyme PON1 has an important role in the attenuation of atherogenic low-density lipoprotein (LDL) oxidation. The aim of this study was to determine PON1 and arylesterase (AREST) enzyme levels in relation to insulin resistance (IR) or obesity among children and adolescents. The study included healthy school children and adolescents. Blood was drawn for the determination of blood glucose, lipid, PON1 and AREST enzyme levels. Overall, we observed a positive correlation between PON1 enzyme activity and high-density lipoprotein cholesterol (HDL-C) levels (r = 0.189, P = 0.014). The correlation appeared to be more significant in boys (r = 0.271, P = 0.009). For subjects with IR and obesity, PON1 enzyme activity did not correlate with HDL-C levels (r = 0.038, P = 0.790), instead PON1 levels correlated negatively with BMI (r = -0.309 and P = 0.026). Multiple linear regression analysis was performed to find the predictors of log PON1 activity. HDL-C level was the strongest predictor of PON1 activity in the lean control group, while BMI appeared to be the strongest predictor in the subjects with obesity or IR. In conclusion, determinants of PON1 enzyme activity are variable in children and adolescents based on IR and obesity. Future studies will shed light on the underlying mechanisms and biomarkers of OS in children and may reveal possible targets for therapeutic intervention.

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.

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.

Epicardial fat thickness and oxidative stress parameters in patients with subclinical hypothyroidism.

INTRODUCTION: Thyroid disorders are known to be a risk factor for cardiovascular diseases. Epicardial fat thickness (EFT) and oxidative stress are also believed to be major risk factors for cardiovascular events. The aim of this study was to evaluate the possible relationship between oxidative stress parameters and EFT in patients with subclinical hypothyroidism (SCH). MATERIAL AND METHODS: A total of 60 individuals (30 patients with SCH and 30 healthy controls) were recruited for the study. The EFT and oxidative stress parameters of all participants were analyzed at baseline; the same were analyzed in SCH patients after achievement of a euthyroid state. RESULTS: Compared to healthy subjects, SCH patients had significantly higher EFT and oxidative stress parameters (p < 0.05 for all). EFT and oxidative stress parameters both decreased after treatment, but only the decrease of EFT levels was statistically significant after thyroid hormone replacement (p < 0.05). Serum EFT levels were not significantly correlated with oxidative stress index (r = 0.141, p = 0.458). CONCLUSIONS: Previous studies have demonstrated that visceral adipose tissue and oxidative stress are major risk factors for cardiovascular events; our study demonstrated that EFT, a visceral adipose tissue, and oxidative stress parameters were higher, and could be used as an indicator for cardiovascular diseases in patients with SCH.

Usefulness of the epicardial fat tissue thickness as a diagnostic criterion for geriatric patients with metabolic syndrome.

OBJECTIVE: To evaluate the epicardial fat tissue thickness (EFTT) as a diagnostic criterion for geriatric patients with metabolic syndrome (MetS). METHODS: Sixty geriatric patients over 65 years of age were recruited for the study. Patients were divided into two groups: Group 1 (n = 30) consisted of patients with MetS; Group 2 (n = 30) consisted of patients without MetS. Echocardiography was used to measure EFTT in all patients, and blood samples were analyzed for biochemical parameters. RESULTS: Compared to Group 2, EFTT levels of Group 1 were statistically higher (P < 0.05). In a binary logistic regression analysis, EFTT levels served as the independent factor for metabolic syndrome (B = 17.35, SE = 4.93, Wald = 12.36, P < 0.001). Receivers operating characteristic Curve (ROC-curve) analysis revealed that EFTT predicted MetS with 96.7% sensitivity and 86.7% specificity above the level of 7.3 mm [area under the curve = 0.969; 95% confidence interval (CI): 0.928-1.00]. CONCLUSIONS: The present study demonstrated that serum EFTT levels were higher in geriatric patients with MetS and can therefore be used as a diagnostic criterion for MetS.

Association of Meteorological Variables and Coronary Blood Flow.

We aimed to assess the impact of meteorological variables on coronary blood flow (CBF). Coronary blood flow was evaluated using the thrombolysis in myocardial infarction frame count (TFC). The association of CBF with meteorological parameters such as temperature, relative humidity, total solar radiation, atmospheric pressure, wind velocity, and total sunshine duration were investigated as well as demographic, clinical, and laboratory characteristics. Assessment of 1206 patients (median age = 53 years, 723 females) revealed the presence of slow coronary flow (SCF) in 196 patients. Daily maximum temperature [odds ratio = 0.951, 95% confidence interval = 0.916-0.986, P = .007] was the only independent predictor of the presence of SCF, whereas systolic blood pressure (ß = -0.139, P = .026), hematocrit level (ß = 0.128, P = .044), and daily maximum temperature (ß = -1.479, P = .049) were independent predictors of log10 (mean TFC). Findings of the present study suggest a role of meteorological parameters in CBF regulation.

Mean platelet volume is not associated with coronary slow flow: a retrospective cohort study.

OBJECTIVE: To investigate mean platelet volume (MPV) levels in patients with coronary slow flow (CSF). METHODS: 465 stable angina pectoris cases with angiographically normal coronary arteries were recruited [coronary slow flow group (n=76), control group (n=389)] in the observational retrospective cohort study. Clinical, biochemical and demographic variables including MPV were noted and coronary blood flow was assessed with TIMI frame count (TFC). RESULTS: Gender, smoking, height, serum creatinine, uric acid levels, hemoglobin, waist/hip ratio, systolic blood pressure but not MPV were significantly different among groups. Independent predictors of CSF were height (p=.029) and serum uric acid level (p=.045). Gender, height, weight, hip circumference, systolic blood pressure, fasting blood glucose, serum urea, creatinine, uric acid levels, hemoglobin and platelet count were associated with mean TFC whereas independent predictors of mean TIMI frame count were height (p=.010) and serum uric acid level (p=.041). CONCLUSION: Height and serum uric acid level but not MPV were independent predictors of both CSF and mean TFC.

Lipoprotein phospholipase A2 in patients with isolated coronary artery ectasia.

OBJECTIVE: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is among the multiple cardiovascular biomarkers that have been associated with increased cardiovascular disease. Lp-PLA2 appears, however, to be relatively unique in its high specificity for vascular inflammation as opposed to systemic inflammation, its low biologic variability, and its direct role in the causal pathway of plaque inflammation. Nevertheless, the relation between LP-PLA2 and isolated coronary artery ectasia (CAE) has not been investigated yet. The aim of our study was to assess this relation. METHODS: Twenty-five patients with isolated CAE without stenosis and 25 control subjects with angiographically normal coronary arteries were included in this study. Lp-PLA2 mass was determined in serum by a dual monoclonal antibody immunoassay. RESULTS: Patients with isolated CAE had significantly higher level of Lp-PLA2 compared to the control subjects with angiographically normal coronary arteries (284 ± 102 ng/ml in ectasia and 199 ± 62 ng/ml in control group, respectively, p 0.001). Also we detected a significant positive correlation between the presence of CAE and Lp-PLA2 (r = 0.452, p 0.001). CONCLUSION: We have demonstrated for the first time increased Lp-PLA2 level in patients with isolated CAE, suggesting that Lp-PLA2 may be involved in the pathogenesis of CAE.