A new marker for the prediction of contrast induced-acute kidney injury following primary percutaneous coronary intervention: logarithm of haemoglobin-albumin product.

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a disorder that adversely affects the prognosis of STEMI. The study aimed to assess the predictive value of a new marker, logarithm of haemoglobin and albumin product (LHAP) on the risk of CI-AKI development after primary percutaneous coronary intervention (p-pci). METHOD: We retrospectively enrolled 3057 patients with ST-elevation acute myocardial infarction who were treated with p-PCI. The primary outcome was CI-AKI, defined as >25% or >0.5 mg/dl increase of baseline creatinine values during post-procedural 48 h. RESULTS: First, a baseline model was produced to determine the predictors of CI-AKI, then haemoglobin, albumin and LHAP were included in the base model and the performances of all models were compared. The predictive accuracy (Likelihood ratio χ2 and R2) and discrimination (ROC-AUC) of the model including LHAP were significantly higher than that of models including both albumin and Hgb. LHAP best cut-off value for the development of CI-AKI was 9.26 (sensitivity 68% and specificity 66%). CONCLUSION: LHAP values were the most important predictor of CI-AKI, followed by creatinine value and Killip class. LHAP values are significantly associated with CI-AKI after p-PCI.

[Effect of pulmonary endarterectomy on six-minute walking test and echocardiography in the early stage]. / Pulmoner endarterektominin erken dönemde alti dakika yürüme testi ve ekokardiyografi parametrelerine etkisi.

OBJECTIVE: Pre- and postoperative changes in echocardiographic parameters and results of 6-minute walking test (6-MWT) were investigated in the present study. METHODS: Seventy-six patients (32 males, 44 females; mean age 45.9±15.1 years) were included. Before and after surgery, 6-MWT and echocardiography were performed. Changes in postoperative parameters were compared to basal walking test and other basal parameters. RESULTS: Distance covered in 6-MWT significantly increased after surgery (p<0.001). Significant decrease in right ventricular diameter and pressure, and significant increase in left ventricular diameter were also observed. While changes in ejection fraction (EF) were not significant, significant reduction in systolic pulmonary artery pressure (sPAP) and tricuspid regurgitation were observed. No statistically significant correlation was observed between baseline 6-MWT results and echocardiographic parameters. CONCLUSION: The present study was the first to investigate the correlation between baseline 6-MWT results and right ventricular echocardiographic parameters. Myocardial performance index (MPI) and TAPSE were important parameters in follow-up after pulmonary endarterectomy. Improvement in quality of life parameters was also important.

Increased arterial stiffness parameters in panic disorder patients in long term treatment period.

BACKGROUND: The relationship between mental stress and cardiovascular disease has been shown in several studies. Panic disorder (PD) is also associated with cardiovascular disease due to increased risk of myocardial infarction. The aim of this study is to evaluate the association between arterial stiffness parameters and depression/anxiety scores in patients with PD. METHODS: The study population consisted of 25 patients with PD and 25 age-sex-matched healthy controls. Depression and anxiety levels were evaluated by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Determination of arterial stiffness parameters was conducted using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. RESULTS: While baseline characteristics were similar between two groups, BDI and BAI scores were significantly higher in patients with PD (p < 0.005). The pulse wave velocity (PWV) and Augmentation Index (AIx) were also significantly higher in patients with PD (p = 0.001, p = 0.006). There was a moderate correlation between PWV and AIx with BAI scores (r = 0.442, p = 0.001, r = 0.441, p = 0.001). AIx was also positively correlated with BDI scores (r = 0.415, p = 0.03). CONCLUSION: We demonstrated a significant relationship between arterial stiffness parameters and anxiety/depression scores in patients with PD who receive antidepressant treatment.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure / Relações Neutrófilo-Linfócito e Plaqueta-Linfócito Como Preditores de Insuficiência Cardíaca

Abstract Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. The aims of this study were to compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up. Methods: This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization. Results: The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average. Conclusion: NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.

Resumo Fundamentos: A obesidade mórbida está diretamente relacionada à deterioração da capacidade cardiorrespiratória, incluindo alterações na modulação autonômica cardiovascular. Objetivo: Este estudo teve por objetivo avaliar a função autonômica cardiovascular de obesos mórbidos. Métodos: Estudo transversal, incluindo dois grupos, Grupo I, composto por 50 obesos mórbidos, e Grupo II, por 30 indivíduos não obesos. A função autonômica foi avaliada pela variabilidade da frequência cardíaca no domínio do tempo [desvio padrão de todos os intervalos R-R normais (SDNN); desvio-padrão de todos os intervalos R-R normais (SDNN); raiz quadrada das médias quadráticas das diferenças dos intervalos R-R sucessivos (RMSSD); e o percentual de diferenças de intervalo intervalos R-R sucessivos maior que 50 milissegundos (pNN50)] em comparação ao adjacente, e no domínio da frequência (HF, do inglês, “high frequency”, e LF, do inglês, “low frequency”: integração da função da densidade espectral de potência para as bandas de alta e baixa frequência, respectivamente). Os grupos foram comparados pelo teste t de Student, considerando-se um nível de significância de 5%. Resultados: Quando comparados aos controles, os indivíduos obesos apresentaram valores menores de SDNN (40,0 ± 18,0 ms vs. 70,0 ± 27,8 ms; p = 0,0004), RMSSD (23,7 ± 13,0 ms vs. 40,3 ± 22,4 ms; p = 0,0030), pNN50 (14,8 ± 10,4 % vs. 25,9 ± 7,2%; p = 0,0061) e HF (30,0 ± 17,5 Hz vs. 51,7 ± 25,5 Hz; p = 0,0023). A relação LF/HF média foi maior no Grupo I (5,0 ± 2,8 vs. 1,0 ± 0,9; p = 0,0189), refletindo alteração no equilíbrio simpato-vagal. Não houve diferença estatística entre os grupos I e II com relação ao índice LF (50,1 ± 30,2 Hz vs. 40,9 ± 23,9 Hz; p = 0,9013). Conclusão: obesos mórbidos apresentam aumento de atividade simpática e redução da atividade parassimpática, caracterizando uma disfunção autonômica cardiovascular.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. The aims of this study were to compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up. METHODS: This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization. RESULTS: The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average. CONCLUSION: NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.

Nonalcoholic Steatohepatitis Score is an Independent Predictor of Right Ventricular Dysfunction in Patients with Nonalcoholic Fatty Liver Disease.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease and impaired left ventricular (LV) function, yet the impact of NAFLD on right ventricular (RV) function remains unclear. We investigate the RV functional properties in patients with NAFLD. METHODS: Ninety consecutive patients with the diagnosis of biopsy-proven NAFLD and 45 age- and sex-matched controls were included. All patients underwent an echocardiographic examination. RV function was evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE). RESULTS: Mean fibrosis stage and nonalcoholic steatohepatitis (NASH) scores were 1.3 ± 1.1 and 5.2 ± 1.6, respectively. NAFLD patients displayed decreased RV function compared to controls. NAFLD patients with liver fibrosis (67 patients) had significantly lower RV function assessed by GLS (global longitudinal strain) compared to patients without liver fibrosis (18.9 ± 3.4% vs. 21.6 ± 2.3%, P < 0.001). NASH score ≥5 was associated with lower RV-GLS (18.9 ± 3.1% vs. 21.0 ± 3.4%, P = 0.006). NASH score inversely correlated with RV-GLS (r = -0.370, P < 0.001) such as patients with impaired RV-GLS (<19%) showed significantly higher NASH score compared to normal RV-GLS group (5.8 ± 1.4 vs. 4.8 ± 1.7, P = 0.009). Logistic regression analysis revealed that NASH score was an independent predictor of impaired RV function in patients with NAFLD. CONCLUSIONS: Patients with NAFLD have impaired RV function. NASH score inversely correlates with RV-GLS and independently predicts impaired RV function in patients with NAFLD.

Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.

The aim of the present study was to evaluate of the right and left heart mechanics by two-dimensional (2D) speckle tracking echocardiography (STE) in chronic thromboembolic pulmonary hypertension (CTEPH) patients before and after pulmonary thromboendarterectomy (PTE). A total of 40 consecutive CTEPH patients (mean age 49.3 ± 13.5 years, 27 female) were included. 2D STE was performed in all patients before, and 3 months, after PTE. 12 months of prognostic data were also recorded via the use of telephone calls. Postoperative 6-minute walk test (6MWT) distances were significantly longer than preoperative values (410.5 ± 61.5 vs. 216.6 ± 131.4 m, p < 0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher than preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher than preoperative values. Postoperative LV global radial and circumferential strain measurements were similar to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher, postoperative LA reservoir and conduit functions were similar to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, and RA reservoir and conduit functions in the preoperative and postoperative periods. 2D STE indices may help the clinician in assessing the effect of PTE on cardiac functions and may also be used for follow-up data in CTEPH patients.

Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography.

BACKGROUND: Atherosclerosis is a chronic systemic inflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are systemic inflammatory markers that are correlated with poor cardiovascular outcomes. AIM: To explore the relation of NLR and PLR with severity of coronary artery disease (CAD). METHODS: The study population consisted of 180 consecutive patients who underwent elective coronary angiography (CAG). While 100 patients (22 female, mean age: 60.6 ± 12.6 years) had abnormal CAG, 80 patients (44 female, mean age: 57.2 ± 10.9 years) had normal CAG. NLR and PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. RESULTS: Although age distribution was similar between the two groups (p = 0.073), female gender was significantly higher in the normal CAG group (p < 0.001). Patients with abnormal CAG had significantly higher NLR and PLR when compared to patients with normal CAG (3.7 ± 2.6 vs. 2.2 ± 1.7, p < 0.001 and 125.9 ± 72.3 vs. 102.6 ± 33.8, p = 0.027, respectively). NLR and PLR were significantly correlated with SYNTAX score and GENSINI score. In logistic regression analyses, only NLR (odds ratio: 1.576, confidence interval: 1.198-2.072, p = 0.001) was an independent predictor of CAD. An NLR of 2.3 or higher predicted the CAD with a sensitivity of 66% and specificity of 70%. CONCLUSIONS: NLR and PLR seem to be a simple method to predict severity of CAD in patients undergoing elective CAG, and it may be part of cardiovascular examination before CAG.

Growth arrest-specific 6 and cardiometabolic risk factors in patients with psoriasis.

OBJECTIVES: An increased risk for cardiovascular disease with psoriasis has been reported. Growth Arrest-Specific 6 (GAS6) amplifies pro-inflammatory endothelial cell activation via TAM receptors. However, it also inhibits inflammation by multiple mechanisms including phagocytosis. The objective of this study was to investigate whether plasma GAS6 levels are associated with conventional cardiometabolic (CM) risk factors in patients with psoriasis. METHODS: Forty patients diagnosed with psoriasis (22 male, mean age: 43.3 ± 13.8 years) and 40 age-/sex-matched healthy controls (22 male, mean age: 39.3 ± 8.9 years) were included in the study. CM risk factors (hypertension, hyperlipidemia, diabetes mellitus, and cigarette smoking) were identified. GAS6 levels were measured by ELISA. RESULTS: There were no significant differences between the plasma GAS6 levels of patients with psoriasis compared to the control group (6.6 ± 2.0 ng/mL, 7.6 ± 2.8 ng/mL, respectively, P > 0.05). However, GAS6 levels of patients with psoriasis having a smoking history (n = 11) were significantly lower than both patients with psoriasis who had no smoking history (n = 29) and controls (5.5 ± 1.7 ng/mL, 6.9 ± 1.9 ng/mL, 7.6 ± 2.8 ng/mL, respectively, P < 0.05). Similarly, psoriasis patients with at least one CM risk factor showed lower GAS6 levels compared to subjects without any CM risk factor (5.7 ± 1.7 ng/mL, 7.3 ± 2.0 ng/mL, P < 0.01). There was no correlation between the GAS6 level, disease duration or PASI score (r = 0.150, -0.150, and P = 0.310, 0.398, respectively). CONCLUSIONS: This pilot study provides the first evidence in humans for an association between low plasma GAS6 levels and conventional risk factors in psoriasis. Further large scale, prospective studies are needed to confirm these results.

Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions.

Arterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 ± 13.2 years) and 50 controls (33 male, mean age 45.0 ± 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 ± 1.78 versus 1.82 ± 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 ± 15.1 and 75.2 ± 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 ± 13.1 versus 17.4 ± 12.3%, p = 0.001 and 6.78 ± 1.42 versus 6.18 ± 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95% confidence interval 1.01-1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02-2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.

Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness.

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and reduced vascular compliance. The purpose of this study was to examine the relationships between arterial stiffness measures, the histological severity of NAFLD, and epicardial fat thickness (EFT). METHODS: A total of 100 patients with biopsy-proven NAFLD and 50 age- and sex-matched controls were enrolled. The histological severity was assessed in all NAFLD patients. Measurements of arterial stiffness [pulse-wave velocity (PWV) and augmentation index (AIx)] were carried out using a Mobil-O-Graph arteriograph system. EFT was assessed by means of echocardiography. RESULTS: Compared with controls, NAFLD patients had significantly higher PWV and AIx values. Stepwise linear regression analysis demonstrated that the liver fibrosis score and EFT were independent predictors of both PWV and AIx values in NAFLD patients. CONCLUSIONS: Patients with NAFLD have an increased arterial stiffness, which reflects both the severity of liver fibrosis and increased EFT values.

Burden and depressive symptoms associated with adult-child caregiving for individuals with heart failure.

BACKGROUND: The primary purpose of this study was to investigate adult-child caregiver burden in heart failure (HF) patients. Secondary purpose of the study was to identify the possible influencing factors for caregiver burden and depressive symptoms in a young adult-child caregiver group. METHODS: A total of 138 adult-child caregivers and 138 patients with HF participated in this study. Caregivers' burden, depressive symptoms, and anxiety levels were assessed by using Zarit Caregiver Burden Scale (ZCBS), Beck Depression Inventory, and State-Trait Anxiety Inventory, respectively. RESULTS: The mean ZCBS scores of the female caregivers were significantly higher than male caregivers. Approximately one-third of the adult-child caregivers had at least mild depressive symptoms. Caregivers with higher depressive symptoms had higher levels of caregiver burden. There were positive correlations between caregiving time, severity of depressive symptoms, and perceived caregiver burden. There was a negative correlation between education level of caregivers and perceived caregiver burden. Age, socioeconomic level, and marital status of patients were affecting factors for depressive symptoms in caregivers. Among caregiver characteristics, gender, marital status, and ZCBS scores seem to influence the depression in caregivers. CONCLUSIONS: The study findings suggest significant levels of burden and depressive symptoms even in adult-child caregivers of HF patients.

Regional myocardial dysfunction assessed by two-dimensional speckle tracking echocardiography in systemic sclerosis patients with fragmented QRS complexes.

BACKGROUND: The aim of the study was to explore the relation between regional myocardial dysfunction and fragmented QRS (fQRS) complexes in systemic sclerosis (SSc). METHODS: Fifty-three SSc patients and 26 controls were included. All subjects underwent speckle tracking echocardiography for evaluation of left ventricular (LV) function and ECG to check for fQRS complexes. RESULTS: SSc patients had significantly lower LV global longitudinal, radial and circumferential strain and twist compared to controls. Thirteen SSc patients had fQRS (DII, DIII, aVF leads in eleven patients and V1 to V5 leads in two patients) and they had significantly lower global longitudinal and circumferencial strain compared to SSc patients with normal QRS. The SSc patients with fQRS in DII, DIII, and aVF leads had impaired longitudinal strain and delay in time to peak longitudinal strain in inferior LV segments compared to those with normal QRS. CONCLUSION: fQRS is associated with lower strain measures in SSc patients indicating impairment in LV function.

Recanalization of a total occlusion with marked retrograde collateral supply: impact of collateral circulation on fractional flow reserve measurements of donor artery.

Fractional flow reserve (FFR)-based coronary interventions of intermediate-severity lesions are safe, cost effective, and have prognostic importance. Although FFR is not affected by heart rate or blood pressure, collateral circulation might affect FFR results. Intermediate stenosis at the donor artery might be overestimated with FFR measurement due to coronary steal. Moreover, the amount of collateral circulation might be a strong determinant of this inaccurate measurement. In this report, we present 8 patients who underwent percutaneous coronary intervention for totally or subtotally occluded recipient vessels that were collateralized by a vessel with intermediate-degree stenosis proximal to the separation of the donor side branch evaluated by quantitative coronary angiography (QCA). In patients with Rentrop grade-2 or grade-3 collateral flow, FFR value of the donor artery was increased at least 0.10 after revascularization of the recipient artery. However, FFR value did not change significantly in patients with Rentrop grade- 0 or grade-1 collateral flow following revascularization. In this case series, we suggest that well-developed collateral circulation might result in overestimation of the FFR value in the donor artery with mild stenosis. Therefore, in patients undergoing intervention to the recipient artery with a well-developed collateral supply and an intermediate stenosis at the donor artery, hemodynamic significance of the stenotic lesion should be evaluated not only before but also after coronary intervention. However, if there is no sufficient collateral circulation to totally occluded arteries, FFR values of donor arteries seem to be relatively stable both before and after PCI to the recipient artery.

Evaluation of alexithymia, somatosensory sensitivity, and health anxiety levels in patients with noncardiac chest pain.

OBJECTIVE: Noncardiac chest pain (NCCP) is seen more frequently in young population and in these patients loss of function is evolving in social and professional areas. The aim of the study is to evaluate the levels of anxiety and somatic perception in patients with chest pain presenting to cardiology clinic. METHODS: Fifty-one patients with noncardiac chest pain and 51 healthy controls were included in the study. All participants performed self-report based health anxiety inventory (HAI), somatosensory amplification scale (SAS), and Toronto alexithymia scale (TAS). RESULTS: The patient group had significantly higher scores on the SAS, HAI-1, and HAI-T scales compared to controls (P < 0.001, P = 0.006, and P = 0.038, resp.). SAS, HAI-1, and HAI-T scores were significantly higher in female patients than male (P = 0.002, 0.036, and 0.039, resp.). There were significant differences in all TAS subscale scores between two groups. Patients, who had total TAS score more than 50, also presented higher levels of health anxiety (P = 0.045). CONCLUSIONS: Anxiety, somatic symptoms, and the exaggerated sense of bodily sensations are common in patients with NCCP. These patients unnecessarily occupy the cardiology outpatient clinics. These negative results can be eliminated when consultation-liaison psychiatry evaluates these patients in collaboration with cardiology departments.

Successful accessory renal artery denervation in a patient with resistant hypertension.

Renal sympathetic denervation is safe and effective in patients with resistant hypertension. In all of the studies of renal artery denervation, patients with accessory renal arteries are excluded. So there is not any data regarding renal sympathetic denervation applied to the accessory renal arteries. We present a young female patient with resistant hypertension despite use of five different antihypertensive drugs. The patient had a well developed (diameter >4 mm) left renal accessory. We believe that if we omitted the well developed accessory renal artery, we would not have maintained adequate blood pressure control. Thus, we applied radiofrequency ablation to both renal arteries and left accessory artery. Immediately after the procedure, the patient's blood pressure was reduced to 110/60 mmHg and this effect was continued during the first month of follow-up.

Increase in QRS amplitudes is better than N-terminal pro-B-type natriuretic peptide to predict clinical improvement in decompensated heart failure.

BACKGROUND: We aimed to investigate the correlation between ECG QRS voltage changes, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and clinical improvement in decompensated heart failure (DHF). METHODS AND RESULTS: DHF patients (n=56) with a mean age of 67.5±12.6 years showed limb QRS amplitude increase and NT-proBNP level decrease with clinical improvement (p<0.001). Significant correlation was found between percent changes (Δ%) in body weight and Δ% in QRS voltages of aVR, aVF, DII, ΣQRSI+II and ΣQRS (all limb-leads) (r = -0.40; r = -0.35; r = -0.32; r = -0.30; r = -0.30 respectively, p<0.05). No correlation was found between Δ% in NT-proBNP and body weight (r = -0.23, p=0.09). Δ% NT-proBNP was correlated with Δ% QRS voltage only in aVR (r = -0.312, p=0.019). In ROC analysis, ≥0.5 mm increase in aVR QRS voltage was found to predict ≥5 kg weight loss with a sensitivity of 74% and specificity of 62% (p=0.013, AUC: 0.699). CONCLUSIONS: Increase in QRS voltages especially in aVR was found to be more sensitive than NT-proBNP to predict clinical improvement in DHF.

Unusual presenting of acute aortic dissection due to penetrating atheromatous ulcer.

Penetrating atheromatous ulcer (PAU) is an atherosclerotic ulcer penetrating the internal elastic lamina of the aortic wall causing a hematoma within the media layer of aorta. They are commonly located in the descending aorta of the elderly and hypertensive patients. They may rarely be complicated by aortic dissection. We report a relative young normotensive patient presenting with acute aortic dissection due to PAU located in the ascending aorta.