Aortic pulse wave velocity and its relationship with complexity of coronary artery disease based on SYNTAX score.

BACKGROUND: Aortic pulse wave velocity (APWV), a marker of arterial stiffness, was found to be a good predictor for the presence of incipient vascular disease and cardiovascular events in observational studies. APWV measured by echo Doppler is a simple and readily available method comparable with other costlier and complex modalities of APWV measurement like MRI, Complior method or applanation tonometry. AIMS AND OBJECTIVES: No previous studies have demonstrated a relationship between APWV findings and the complexity of coronary artery disease (CAD). Our aim was to examine the relationship between APWV findings and the severity of SYNTAX scores (SX scores). METHODS: 500 patients who had undergone APWV measurements and elective coronary angiography from September 2012 to June 2013 were taken. Pulsed Doppler ultrasound (6.6 MHZ) probe with ECG synchronisation was used to calculate APWV. SYNTAX scoring was performed by observers who were blinded to APWV values. RESULTS: A significant, nearly linear correlation between APWV and advancing CAD (p<0.0001) was observed. Patients with dual-vessel and triple-vessel disease had significantly higher APWV than patients without CAD. It was also found that mean APWV values were significantly more in patients with high or intermediate SX scores than in patients with low SX scores. The Fischer's linear discriminant analysis showed a cut-off value of APWV for predicting the possibility of having CAD to be >11.5 m/s. CONCLUSIONS: APWV has predictive value for the SX score. A positive relation exists between aortic stiffening and coronary atherosclerosis and APWV measured by 2D Doppler is a good predictor of advancing CAD.

The medical treatment of endomyocardial fibrosis in 2009.

OBJECTIVES: To study the natural history of medically treated patients with endomyocardial fibrosis (EMF) and to see whether the usage of common drugs affected survival. DESIGN: A real-world all-comers analysis with follow-up. SETTING: A teaching hospital. ANALYSIS: Cox proportional hazards multiple regression and Kaplan-Meier curves for survival with both univariate and multivariate analysis. RESULTS: The mean age of this population was 40.5±5 years at first symptom. The mortality was also less than previous reports at 10.38%. The dominant type of EMF was dominant left ventricular EMF in 49, right ventricular EMF in 52 and biventricular EMF in 53. On univariate analysis by Kaplan-Meier curves and log-rank test patients on warfarin had a better survival (at 5, 10 and 15 years-97.3, 87.54% and 87.54%, respectively) compared with no warfarin at 5, 10 and 15 years (91.37%, 88.9% and 66.68%), log rank test NS. On multivariate analysis when sex, the presence of complications, use of ACE inhibitors, use of aldactone, use of digoxin, frusemide and warfarin and age (age at entering the study) were entered into the analysis, the following results were obtained-men had a shorter time to death. Furthermore, when patients taking aldactone and those not taking aldactone were examined it was found that those on aldactone had a higher mortality and shorter time to death. CONCLUSION: On analysis of the usage of warfarin, those not on it had a shorter time to death; likewise did older patients.