Relationship between P wave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome.

BACKGROUND: Early diagnosis of non-ST elevation acute coronary syndrome (NSTE-ACS) and prediction of the severity of current coronary artery disease (CAD) play a major role in patient prognosis. Electrocardiography has a unique value in the diagnosis and provides prognostic information on patients with NSTE-ACS. In the present study, we aimed to examine the relationship between P wave peak time (PWPT) and the severity of CAD in patients with NSTE-ACS. METHODS: A total of 132 consecutive patients (female: 35.6%; mean age: 60.1 ± 11.6 years) who were diagnosed with NSTE-ACS were evaluated retrospectively. Gensini scores (GSs) were used to define the angiographic characteristics of the coronary atherosclerotic lesions. The patients were divided into two groups according to the GS. The PWPT was defined as the duration between the beginning and the peak of the P wave, and R wave peak time (RWPT) was defined as the duration between the beginning of the QRS complex and the peak of the R wave. RESULTS: There were 59 (44.6%) patients in the high-GS group (GS ≥25 ) and 73 (55.3%) patients in the low-GS group (GS <25 ). Presence of diabetes mellitus, low left ventricular ejection fraction, and high RWPT and PWPT were identified as predictors of a high GS in the study population. There was no significant difference between the area under the curves of PWPT and RWPT for predicting the severity of CAD (0.663 vs. 0.623, respectively; p = 0.573). CONCLUSION: The present study found that both PWPT and RWPT on admission electrocardiography were associated with the severity and complexity of CAD in patients with NSTE-ACS.

Atrial peak longitudinal strain may be predictive of pancolitis in patients with ulcerative colitis.

BACKGROUND: Ulcerative colitis is a chronic idiopathic inflammatory bowel disease of the colon that is characterized by a relapsing and remitting course. Previous studies have shown that arterial stiffness, carotid intima media thickness, atrial electromechanical delay, and global longitudinal strain suggested subclinical cardiovascular disorders in ulcerative colitis patients. The aims of our study was to evaluate the left atrial function of patients with ulcerative colitis by using speckle tracking echocardiography, and to assess the relationship between echocardiographic variables and the extent of the disease. METHODS: We recruited 51 outpatients with ulcerative colitis in remission phase and 52 healthy volunteers. The ulcerative colitis patients were evaluated by for the extent of the disease by endoscopy at the initial diagnosis. RESULTS: E/Em , left atrial volume, and left atrial stiffness index were higher, and peak atrial longitudinal strain was lower in pancolitis than in non-pancolitis patients. In the multivariate logistic regression test, peak atrial longitudinal strain and E/Em were found to be independent predictors for pancolitis. CONCLUSION: Early detection of myocardial abnormalities by conventional echocardiography and speckle tracking echocardiography, which is a simple and non-invasive technique, may be useful for giving insights to the extent of the disease in ulcerative colitis patients.

Morphologic and Functional Changes in Right-Sided Cardiac Chambers in Patients With Chronic Liver Disease and Normal Pulmonary Artery Pressure.

OBJECTIVES: To investigate the effects of chronic liver disease (CLD) on the structural and functional characteristics of right-sided heart chambers in patients with normal pulmonary artery pressure. METHODS: Fifty-one patients with known CLD but without pulmonary hypertension or other cardiovascular conditions were consecutively enrolled, along with 25 age- and sex-matched participants. Patients with CLD were classified according to the Model of End-Stage Liver Disease score and Child-Pugh classification. Right ventricular (RV) and right atrial (RA) dimensions, indices of RV systolic/diastolic function, and myocardial strain were measured by standard echocardiographic methods. RESULTS: Patients in the study group had similar RV end-diastolic, end-systolic, and RA dimensions compared to controls. Similarly, neither the conventional indices of RV systolic/diastolic function nor the strain imaging findings were different between groups (P > .05). Only RV free wall thickness was significantly higher in the study group (mean ± SD, 4.15 ± 0.64 versus 3.75 ± 0.37 mm; P < .001). Right ventricular end-diastolic diameter (P = .018; r = 0.334) and RA area (P = .017; r = 0.335) had a significant correlation with RV free wall thickness in patients with CLD. Patients treated with beta blockers were found to have a significant reduction in mean RV free wall strain compared to patients who did not receive beta blocker treatment (-20.37 ± 6.6 versus -24.07 ± 6.52; P = .04). CONCLUSIONS: Patients with CLD had increased RV free wall thickness despite normal systolic pulmonary pressure, presumably secondary to cirrhotic cardiomyopathy. In the absence of pulmonary hypertension, however, cirrhotic cardiomyopathy did not cause impaired RV systolic or diastolic function.

The Effect of Glucose Variability on QTc Duration and Dispersion in Patients with Type 2 Diabetes Mellitus.

OBJECTIVE: Glycemic variability (GV) is a new term with the episodes of hyper and hypoglycemia in diabetic patients. Both prolonged QT interval and QTd are potential risk factors for malignant ventricular arrhythmias affecting the mortality of different groups of patients including diabetes mellitus. In this study, we aimed to evaluate if the glucose variability increasing the QTc interval and QTc dispersion in type 2 diabetes mellitus. METHODS: We included 275 consecutive patients with type 2 diabetes. We quantified the GV with standard deviation (SD) and coefficient of variation (CV) from 7 point glucose measures. We investigated the relationship of GV parameters with QT parameters. RESULTS: The prevalence of prolonged QTc duration was 21%, no patients have prolonged QTc dispersion (> 80 ms). SD of the patients with prolonged QTc duration was significantly higher than the others (45.14 ±24.45 vs. 37.78 ±9.03 p<0.05). There was also a significant relationship between SD and QTc dispersion (r: 0.164; p: 0.007). There were no relationship between the QT parameters and microvascular diabetic complications. SD and HbA1c levels were significantly higher on the patients having peripheral neuropathy (p<0.005). CONCLUSION: The result of this study demonstratess that increased glycemic variability is associated with prolonged QTc duration and QTc dispersion. It is important to focus on targeting optimal glycemic control with GV as an additional goal point along with the traditional following parameters such as fasting-postprandial blood glucose and HbA1c.

Evaluation of the relation between cardiac biomarkers and thorax computed tomography findings in COVID-19 patients.

Background: Troponin levels may be elevated in COVID-19 infection. The aim of this study was to the explore relation between troponin levels and COVID-19 severity. Materials, methods & Results: One hundred and forty consecutive patients with COVID-19 pneumonia were included. Diagnosis of COVID-19 pneumonia was based on positive chest computed tomography (CT) findings. Quantitative PCR test was performed in all patients. Only 74 patients were quantitative PCR-positive. Twenty four patients had severe CT findings and 27 patients had progressive disease. These patients had significantly lower albumin and higher ferritin, D-dimer, lactate dehydrogenase, C-reactive protein, and high-sensitivity cardiac troponin I (hs-cTnI). Conclusion: COVID-19 patients with severe CT findings and progressive disease had higher hs-cTnI levels suggesting the use of hs-cTnI in risk stratification.

The effect of moderate and severe COVID-19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis.

It has been reported that myocardial damage and heart failure are more common in COVID-19 patients with severe symptoms. The aim of our study was to measure the right ventricular functions of COVID-19 patients 30 days after their discharge, and compare them to the right ventricular functions of healthy volunteers. Fifty one patients with COVID-19 and 32 healthy volunteers who underwent echocardiographic examinations were enrolled in our study. 29 patients were treated for severe and 22 patients were treated for moderate COVID-19 pneumonia. The study was conducted prospectively, in a single center, between 15 May 2020 and 15 July 2020. We analyzed the right ventricular functions of the patients using conventional techniques and two-dimensional speckle-tracking. Right ventricular end-diastolic and end-systolic area were statistically higher than control group. The right ventricular fractional area change (RVFAC) was significantly lesser in the patient group compared to the control group. Tricuspid annular plane systolic motion (TAPSE) was within normal limits in both groups, it was lower in the patient group compared to the control group. Pulmonary artery pressure was found to be significantly higher in the patient group. Right ventricular global longitudinal strain (RV-GLS) was lesser than the control group (- 15.7 [(- 12.6)-(- 18.7)] vs. - 18.1 [(- 14.8)-(- 21)]; p 0.011). Right ventricular free wall strain (RV-FWS) was lesser in the patient group compared to the control group (- 16 [(- 12.7)-(- 19)] vs - 21.6 [(- 17)-(- 25.3)]; p < 0.001). We found subclinical right ventricular dysfunction in the echocardiographies of COVID-19 patients although there were no risk factors.

The relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction.

BACKGROUND: The Synergy between Percutaneous Coronary Intervention (SYNTAX) score, has been used to estimate the extent and complexity of coronary artery disease (CAD). The H2FPEF score enables robust discrimination of heart failure with preserved ejection fraction (HFpEF) from non-cardiac aetiologies of dyspnea. In the present study, we aimed to investigate the relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction (NSTEMI). METHOD: Two hundred eighty two consecutive patients with NSTEMI who underwent coronary angiographic examination were enrolled in this study. The H2FPEF score was calculated for each patient on admission. All patients underwent coronary angiography within 2 days following their admission. The SYNTAX scoring system was used to evaluate the severity and extent of CAD. RESULTS: The mean H2FPEF Score [3(2-4) vs 1(0.5-1.5), p < .001] and the frequencies of diabetes mellitus, hypertension and, atrial fibrillation were significantly higher and LVEF was significantly lower in patients with high SYNTAX score. High H2FPEF Score (OR: 3.61, 95%CI: 2.64-4.93; p = .001) and low left ventricular ejection fraction (OR: 0.94, 95%CI: 0.89-0.98; p = .013) were found to be independent associates for high SYNTAX score. H2FPEF Score above a cut-off level of 2.5 predicted high SYNTAX score with a sensitivity of 80% and a specificity of 82.5% (AUC: 0.890; 95%CI: 0.848-0.931; p < .001). There was a significant and moderate positive correlation between H2FPEF and SYNTAX Scores (r = 0.694, p < .001). CONCLUSION: High H2FPEF score may be associated with high SYNTAX score and may be used to estimate the extent and complexity of CAD in NSTEMI patients.

The relationship between presystolic wave and nondipper hypertension.

BACKGROUND: A presystolic wave (PSW) is commonly seen on Doppler examination of the left ventricular outflow tract (LVOT), and the possible mechanism for PSW is considered to be left ventricular stiffness and impaired LV compliance. We aimed to compare the relationship between PSW and dipper, nondipper hypertension. PATIENTS AND METHODS: A total of 83 patients were included in the study. The participating patients were divided into two groups as 42 patients with dipper hypertension and 41 patients with nondipper hypertension based on the results of ambulatory blood pressure monitoring. RESULTS: Left ventricular mass index (91.6 ± 12.9 vs. 106.1 ± 7.9, P < 0.001) and E/Em (7.4 [6.6-8.3] vs. 10 [8-12], P < 0.001) were significantly higher, and Em (9.9 ± 2.7 vs. 7.9 ± 3.4, P = 0.004) was significantly lower in the nondipper group compared with dipper group. And also, the PSW was found to be higher in the nondipper group. The nondipper group had markedly increased frequencies of PSW compared with the dipper group (68 vs. 38%, respectively, P = 0.008). In the multivariate logistic regression test, E/Em [odds ratio (OR) 1.464, 95% confidence interval (CI): 1.113-1.926, P = 0.006] and the presence of PSW (OR 3.115, 95% CI: 1.061-9.143, P = 0.039) were determined as independent predictive parameters for nondipper hypertension. CONCLUSION: The presence of PSW on transthoracic echocardiography suggests that we may come across nondipper hypertension and a high risk of end-organ damage. PSW may be used as a useful parameter in risk stratification in hypertensive patients.

Dissection of the ascending thoracic aorta as a complication of percutaneous coronary intervention.

Acute aortic dissection is a medical emergency with high morbidity and mortality requiring emergent diagnosis and therapy. A 79-year-old woman with acute aortic dissection due to percutaneous coronary intervention was presented. Aortic dissection is an uncommon but potentially lethal illness that can present in an occult manner making the initial diagnosis difficult. Aggressive medical management is mandatory, as well as urgent diagnostic testing and cardiothoracic consultation.

Immediate and six months clinical and angiographic results of intracoronary paclitaxel-coated stent implantation - the Meo:DrugStar-1 study.

The study was conducted to evaluate the clinical and angiographic results of the implantation of the paclitaxel-eluting stent Meo:DrugStar ST in patients with symptomatic coronary artery disease. The Meo:DrugStar ST stent has a stainless steel stent platform with a homogenous non-biodegradable coating of paclitaxel mixed with a polyether-based biostable, monophase, and hemocompatible coating. Sixty patients with native coronary artery disease were included in the study. The Meo:DrugStar ST stents were implanted in 60 de novo lesions detected in these patients. Immediate and long-term clinical and angiographic follow-up results were evaluated. There was a high proportion of patients with hypertension (55%) according to JNC-VII. Mean stenosis ratio was 78 +/- 13 %, mean implanted stent diameter was 3.0 +/- 0.4 mm and mean length was 22 +/- 5 mm. Restenosis was detected in 4 (10%) of those patients and 11 (27.5%) of 40 patients had insignificant amount of restenosis. The results of this study indicate a potential benefit of the Meo:DrugStar ST stent for the prevention of stent thrombosis and restenosis in these relatively high-risk patients.

Does the prevalence of nasal polyps increase in patients using statins?

Several statins inhibit T-helper 1 development and induce T-helper 2 polarization and production of T-helper 2 cytokines that promote the activation and chemotaxis of eosinophils. Whether statins promote the development of nasal polyps has so far been uncertain. No studies have evaluated the frequency of the development of nasal polyps in patients using statins. To better define the relationship of statin use to the presence of nasal polyps, the investigators explored the frequency of the development of nasal polyps in patients who were using statins. A total of 200 patients who were using statins and 200 who were not using statins (400 cases) were investigated. All patients were examined for nasal polyps by anterior rhinoscopy or investigation with a fiberoptic endoscope. In addition, immunoglobulin E levels were measured, a skin prick test was performed, and the results from the 2 groups were compared. Nasal polyps were detected in 4 subjects who were using statins, whereas 5 nasal polyps were found in the control group; differences between the 2 groups were statistically insignificant (P>.05). When the atopy status of the 2 groups was compared, prick test positivity and serum immunoglobulin E levels were found to be 15% and 44+/-31 IU/mL in the statin group and 19% and 68+/-23 IU/mL in the control group (P>.05). These results show that nasal polyposis is a multifactorial disease with several different causes; however, the frequency of the development of nasal polyps does not increase in patients who use statins.

A new effect of acetylsalicylic acid? Significantly lower prevalence of nasal carriage of Staphylococcus aureus among patients receiving orally administered acetylsalicylic acid.

We aimed to evaluate effect of acetylsalicylic acid on the prevalence of nasal carriage of Staphylococcus aureus. Patients were orally administered a prophylactic dose of acetylsalicylic acid and then were compared with control subjects. The prevalence of nasal carriage of S. aureus was significantly lower among patients who received acetylsalicylic acid than among the control subjects (P<.001).

Holter analyses in children with adenotonsillar hypertrophy.

OBJECTIVE: The cardiac complications of adenotonsillar hypertrophy (ATH) have been investigated by many scientists by using supplemental diagnostic modalities such as echocardiography. But, arrhythmia analysis has not been studied adequately in patients with ATH. This study aimed at evaluating the prevalence of arrhythmias, heart rate variability (HRV) and heart rate turbulence (HRT) analyses by means of 24 h Holter ECG monitoring in pre- and post-operative periods in children with ATH. METHODS: Twenty-five children with ATH consisting of 12 female and 13 male patients (mean age 66+/-15 months, range 24-108 months) included in this study. All children were assessed pre-operatively and at 1 month post-operatively with 24-h Holter monitoring and ECG analysis. The prevalence analysis of arrhythmias, heart rate variability and heart rate turbulence analysis was assessed. These data were compared. RESULTS: Although some ECG and holter findings such as sinusal tachycardia, Mobitz type 1 second-degree AV block improved after the operation, the prevalence of arrhythmias, HRV and HRT values were not changed significantly in post-operative period (p>0.05). CONCLUSION: Measurement of HRT and HRV are attractive and easily applicable ways of non-invasive risk prediction of cardiac complications. But, these parameters have not changed significantly in post-operative period. However, ECG and 24-h Holter monitoring of electrocardiography may be useful at evaluating the prevalence of arrhythmias and determining cardiac complications in pre-operative period.

Myocardial bridging of obtuse marginal branch of the left circumflex artery associated with congenital corrected transposition of the great arteries.

A 54-year-old male was admitted to the emergency department with progressive dyspnea and chest pain during exercise. Congenital corrected transposition of the great arteries was detected on echocardiography. Coronary angiography revealed myocardial bridging on the obtuse marginal branch of the left circumflex coronary artery. Being a rare complex cardiac anomaly we discussed the congenitally corrected transposition of the great arteries (CCTGA) in association with myocardial bridging.

Iatrogenic left main coronary artery thrombosis during percutaneous coronary intervention.

During diagnostic angiographic procedures or percutaneous coronary angioplasty-stenting of the other coronary arteries, the overall risk for a complication related to the left main coronary artery (LMCA) is low; however, if such complications occur, they tend to be life-threatening and contribute to a large part of the total catheter-related mortality. We encountered a case of iatrogenic significant subtotal left main coronary artery thrombotic stenosis in a patient who had undergone prior percutaneous transluminal coronary artery angioplasty-stenting of the left circumflex artery. In light of the literature, an extremely rare clinical presentation of iatrogenic left main coronary artery thrombosis is discussed.

Immediate and six months clinical and angiographic results of intracoronary Ephesos stent implantation: the "Ephesos-1" study.

BACKGROUND: This study was conducted to evaluate the clinical and angiographic results of the Ephesos stent implantation in patients with symptomatic coronary artery disease. The Ephesos stent is a new balloon-expandable, stainless steel, tubular stent with multicellular design. METHODS: One hundred ten patients with native coronary artery disease were included in the study. The Ephesos stents were implanted in 163 de novo lesions detected in these patients. Immediate and long-term clinical and angiographic follow-up results were evaluated. RESULTS: Most of the patients had unstable angina 63.6%, and 36.7% of the lesions were type B and C. Mean lesion length was 12.7 +/- 4.7. In 62% of the patients the reference lumen diameter was < 3 mm. One Q-wave and one non-Q-wave myocardial infarction (MI) occurred due to acute thrombotic occlusion during hospital stay. The 6-month event-free survival rate was 77.3%. No patients died in the six-month follow-up period, but 2 patients had non-Q wave MI and 1 patient experienced Q-wave MI within this period. Control angiographic data was collected from 110 patients (100% of patients and a total of 163 lesions). Angiographic restenosis rate was 18.1%. Twenty-two patients with restenosis had repeated target lesion balloon dilatation. CONCLUSION: The results of the present study showed that the Ephesos stent is a safe and effective choice with a low incidence of major adverse cardiac events and restenosis rate within six months of follow-up.

The relationship between P wave dispersion and diastolic dysfunction.

We investigated the relationship between P wave dispersion, which is easily measured on the surface electrocardiogram and may be used in evaluating the risk of atrial fibrillation, and left ventricular diastolic function. There were 133 patients: 73 with diastolic dysfunction and 60 without. P wave dispersions were calculated by measuring minimum and maximum P wave duration values on the surface electrocardiogram. The relationships between P wave dispersion and the presence, cause, severity, and echocardiographic measurements of diastolic dysfunction were investigated. P wave dispersion was 53 +/- 9 ms in patients with diastolic dysfunction and 43 +/- 9 ms in the control group (P < 0.01). When patients were grouped according to stage of diastolic dysfunction, P wave dispersion was 48 +/- 7 ms in stage 1, 54 +/- 8 ms in stage 2, and 58 +/- 9 ms in stage 3. As the severity of diastolic dysfunction increased, P wave dispersion increased but the difference did not reach statistical significance (P < 0.05). When the cause of diastolic dysfunction was considered, P wave dispersion was 53 +/- 8 ms in patients with ischemic heart disease and 52 +/- 9 ms in patients with left ventricular hypertrophy (P > 0.05). We conclude that P wave dispersion increases in diastolic dysfunction, but that this increase is not related to the severity or cause of diastolic dysfunction. When clinical and echocardiographic variables are taken into account, there is a weak but significant correlation only between P wave dispersion and left ventricular ejection fraction.

Dissolution of a huge spontaneous coronary artery thrombus with a new antiplatelet agent and coronary angioplasty.

A huge thrombus was observed in the proximal portion of the right coronary artery (RCA) in a 75-year-old patient. He presented with symptoms of cardiogenic shock due to acute myocardial infarction. Glycoprotein IIb/IIIa inhibitor (Tirofiban) was administered intra-coronary first, coronary angioplasty was performed later and, dramatic thrombus dissolution was observed on control coronary angiography.

Acute myocardial infarction secondary thrombosis associated with ovarial hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complication of controlled ovarian stimulation. Cerebral infarction, myocardial infarction, death and vascular thrombotic events associated with OHSS had been reported. We report a case of a patient with myocardial infarction associated with OHSS.

Sinus of Valsalva aneurysm as a cause of right proximal coronary artery spasm.

Sinus of Valsalva aneurysm (SVA) is an infrequent cardiac anomaly. Variations in the origin and course or distribution of the epicardial coronary arteries are rarely found in the population. SVA can be acquired, secondary to infectious, degenerative or traumatic processes. This paper describes congenital right SVA and abnormal origin of conus branch of right coronary artery as a cause of acute coronary syndrome. After surgical repair of the SVA, the prognosis is usually good, and the risk of recurrence is rare.