Índice Imunoinflamatório Sistêmico como Determinante de Carga Aterosclerótica e Pacientes de Alto Risco com Síndromes Coronarianas Agudas / Systemic Immune-Inflammatory Index as a Determinant of Atherosclerotic Burden and High-Risk Patients with Acute Coronary Syndromes

Resumo Fundamento O índice imunoinflamatório sistêmico (IIS), derivado das contagens de neutrófilos, plaquetas e linfócitos, representa o equilíbrio homeostático entre os estados inflamatório, imune e trombótico. O IIS é superior a índices como a relação neutrófilos-linfócitos no prognóstico de várias malignidades, além de ser um melhor preditor de futuros eventos cardíacos que os fatores de risco tradicionais após a intervenção coronariana. Objetivos Este estudo objetivou avaliar a relação do IIS com a carga aterosclerótica e complicações hospitalares em pacientes com síndrome coronariana aguda. Métodos Desfechos clínicos, como extensão do dano miocárdico, carga aterosclerótica, sangramento, insuficiência renal aguda, duração da internação e mortalidade hospitalar, foram avaliados em uma coorte retrospectiva de 309 pacientes consecutivos com síndrome coronariana aguda. O IIS foi calculado como (plaqueta x neutrófilos)/contagem de linfócitos na admissão. A população estudada foi categorizada em tercis de IIS. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados Os maiores valores de IIS foram encontrados em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (641,4 com angina pectoris instável, 843,0 com infarto do miocárdio sem supradesnivelamento do segmento ST e 996,0 com infarto do miocárdio com supradesnivelamento do segmento ST; p=0,004). Concentração máxima de troponina (0,94 versus 1,26 versus 3; p<0,001), número de vasos doentes (1 versus 2 versus 2; p<0,001), escore SYNTAX ( The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery — sinergia entre intervenção coronária percutânea com taxus e cirurgia cardíaca) (9 versus 14 versus 17,5; p<0,001) e duração da internação (2 versus 2 versus 3; p<0,001) também aumentaram de acordo com o tercil de IIS (tercil 1 versus tercil 2 versus tercil 3). O IIS foi um preditor independente de escore SYNTAX (ß: 0,232 [0,001 a 0,003]; p<0,001), extensão do dano miocárdico (ß: 0,152 [0 a 0,001]; p=0,005) e duração da internação (ß: 0,168 [0,0 a 0,001]; p=0,003). Conclusões Este estudo demonstrou que o IIS, um índice hematológico simples, é um marcador melhor de carga aterosclerótica e internação mais longa do que fatores de risco bem conhecidos em pacientes com síndrome coronariana aguda de alto risco.

Abstract Background Systemic immune-inflammatory index (SII), which is derived from neutrophil, platelet and lymphocyte counts, represents the homeostatic balance among inflammatory, immune and thrombotic status. The systemic immune-inflammatory index is superior to indices such as neutrophil-lymphocyte ratio in predicting prognosis in various malignancies, while it is shown to predict future cardiac events better than traditional risk factors after coronary intervention. Objectives Herein, we aimed to evaluate the relationship of the systemic immune-inflammatory index with atherosclerotic burden and in-hospital complications in acute coronary syndrome patients. Methods The clinical outcomes, such as extent of myocardial damage, atherosclerotic burden, bleeding, acute kidney injury, duration of hospital stay and in-hospital mortality, were evaluated in a retrospective cohort of 309 consecutive acute coronary syndrome patients. The systemic immune-inflammatory index was calculated as (Platelet X Neutrophil)/Lymphocyte count on admission. Study population was categorized into tertiles with regard to systemic immune-inflammatory index. A p value of <0.05 was considered statistically significant. Results The highest systemic immune-inflammatory index values were within ST elevation myocardial infarction patients (641.4 in unstable angina pectoris, 843.0 in non-ST elevation myocardial infarction patients and 996.0 in ST elevation myocardial infarction patients; p=0.004). Maximal troponin concentration (0.94 vs. 1.26 vs. 3; p<0.001), number of diseased vessels (1 vs. 2 vs. 2; p<0.001), the SYNTAX (synergy between percutaneous coronary intervention with taxus and coronary artery bypass grafting) score (9 vs. 14 vs. 17.5; p<0.001) and duration of hospital stay (2 vs. 2 vs. 3; p<0.001) also increased with increasing SIItertile(tertile1 vs. tertile 2 vs. tertile 3). Systemic immune-inflammatory index was an independent predictor of SYNTAX score (ß: 0.232 [0.001 to 0.003]; p<0.001), extent of myocardial damage (ß: 0.152 [0 to 0.001]; p=0.005) and duration of hospital stay (ß: 0.168 [0.0 to 0.001]; p=0.003). Conclusions This study has demonstrated that the systemic immune-inflammatory index, a simple hematological index, is a marker of atherosclerotic burden and longer hospital stay on well-known risk factors in high risk acute coronary syndrome patients.

Systemic Immune-Inflammatory Index as a Determinant of Atherosclerotic Burden and High-Risk Patients with Acute Coronary Syndromes. / Índice Imunoinflamatório Sistêmico como Determinante de Carga Aterosclerótica e Pacientes de Alto Risco com Síndromes Coronarianas Agudas.

BACKGROUND: Systemic immune-inflammatory index (SII), which is derived from neutrophil, platelet and lymphocyte counts, represents the homeostatic balance among inflammatory, immune and thrombotic status. The systemic immune-inflammatory index is superior to indices such as neutrophil-lymphocyte ratio in predicting prognosis in various malignancies, while it is shown to predict future cardiac events better than traditional risk factors after coronary intervention. OBJECTIVES: Herein, we aimed to evaluate the relationship of the systemic immune-inflammatory index with atherosclerotic burden and in-hospital complications in acute coronary syndrome patients. METHODS: The clinical outcomes, such as extent of myocardial damage, atherosclerotic burden, bleeding, acute kidney injury, duration of hospital stay and in-hospital mortality, were evaluated in a retrospective cohort of 309 consecutive acute coronary syndrome patients. The systemic immune-inflammatory index was calculated as (Platelet X Neutrophil)/Lymphocyte count on admission. Study population was categorized into tertiles with regard to systemic immune-inflammatory index. A p value of <0.05 was considered statistically significant. RESULTS: The highest systemic immune-inflammatory index values were within ST elevation myocardial infarction patients (641.4 in unstable angina pectoris, 843.0 in non-ST elevation myocardial infarction patients and 996.0 in ST elevation myocardial infarction patients; p=0.004). Maximal troponin concentration (0.94 vs. 1.26 vs. 3; p<0.001), number of diseased vessels (1 vs. 2 vs. 2; p<0.001), the SYNTAX (synergy between percutaneous coronary intervention with taxus and coronary artery bypass grafting) score (9 vs. 14 vs. 17.5; p<0.001) and duration of hospital stay (2 vs. 2 vs. 3; p<0.001) also increased with increasing SIItertile(tertile1 vs. tertile 2 vs. tertile 3). Systemic immune-inflammatory index was an independent predictor of SYNTAX score (ß: 0.232 [0.001 to 0.003]; p<0.001), extent of myocardial damage (ß: 0.152 [0 to 0.001]; p=0.005) and duration of hospital stay (ß: 0.168 [0.0 to 0.001]; p=0.003). CONCLUSIONS: This study has demonstrated that the systemic immune-inflammatory index, a simple hematological index, is a marker of atherosclerotic burden and longer hospital stay on well-known risk factors in high risk acute coronary syndrome patients.

FUNDAMENTO: O índice imunoinflamatório sistêmico (IIS), derivado das contagens de neutrófilos, plaquetas e linfócitos, representa o equilíbrio homeostático entre os estados inflamatório, imune e trombótico. O IIS é superior a índices como a relação neutrófilos-linfócitos no prognóstico de várias malignidades, além de ser um melhor preditor de futuros eventos cardíacos que os fatores de risco tradicionais após a intervenção coronariana. OBJETIVOS: Este estudo objetivou avaliar a relação do IIS com a carga aterosclerótica e complicações hospitalares em pacientes com síndrome coronariana aguda. MÉTODOS: Desfechos clínicos, como extensão do dano miocárdico, carga aterosclerótica, sangramento, insuficiência renal aguda, duração da internação e mortalidade hospitalar, foram avaliados em uma coorte retrospectiva de 309 pacientes consecutivos com síndrome coronariana aguda. O IIS foi calculado como (plaqueta x neutrófilos)/contagem de linfócitos na admissão. A população estudada foi categorizada em tercis de IIS. Valores de p<0,05 foram considerados estatisticamente significativos. RESULTADOS: Os maiores valores de IIS foram encontrados em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (641,4 com angina pectoris instável, 843,0 com infarto do miocárdio sem supradesnivelamento do segmento ST e 996,0 com infarto do miocárdio com supradesnivelamento do segmento ST; p=0,004). Concentração máxima de troponina (0,94 versus 1,26 versus 3; p<0,001), número de vasos doentes (1 versus 2 versus 2; p<0,001), escore SYNTAX ( The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery ­ sinergia entre intervenção coronária percutânea com taxus e cirurgia cardíaca) (9 versus 14 versus 17,5; p<0,001) e duração da internação (2 versus 2 versus 3; p<0,001) também aumentaram de acordo com o tercil de IIS (tercil 1 versus tercil 2 versus tercil 3). O IIS foi um preditor independente de escore SYNTAX (ß: 0,232 [0,001 a 0,003]; p<0,001), extensão do dano miocárdico (ß: 0,152 [0 a 0,001]; p=0,005) e duração da internação (ß: 0,168 [0,0 a 0,001]; p=0,003). CONCLUSÕES: Este estudo demonstrou que o IIS, um índice hematológico simples, é um marcador melhor de carga aterosclerótica e internação mais longa do que fatores de risco bem conhecidos em pacientes com síndrome coronariana aguda de alto risco.

Role of Sodium Levels on Atrial Fibrillation in Heart Failure: Active Player or a Bystander? / Papel dos Níveis de Sódio na Fibrilação Atrial na Insuficiência Cardíaca: Jogador Ativo ou Bystander?

BACKGROUND: The coexistence of hyponatremia and atrial fibrillation (AF) increases morbidity and mortality in patients with heart failure (HF). However, it is not established whether hyponatremia is related to AF or not. OBJECTIVE: Our study aims to seek a potential association of hyponatremia with AF in patients with reduced ejection fraction heart failure (HFrEF). METHODS: This observational cross-sectional single-center study included 280 consecutive outpatients diagnosed with HFrEF with 40% or less. Based on sodium concentrations ≤135 mEq/L or higher, the patients were classified into hyponatremia (n=66) and normonatremia (n=214). A p-value <0.05 was considered significant. RESULTS: Mean age was 67.6±10.5 years, 202 of them (72.2%) were male, mean blood sodium level was 138±3.6 mEq/L, and mean ejection fraction was 30±4%. Of those, 195 (69.6%) patients were diagnosed with coronary artery disease. AF was detected in 124 (44.3%) patients. AF rate was higher in patients with hyponatremia compared to those with normonatremia (n=39 [59.1%] vs. n=85 [39.7%), p= 0.020). In the logistic regression analysis, hyponatremia was not related to AF (OR=1.022, 95% CI=0.785-1.330, p=0.871). Advanced age (OR=1.046, 95% CI=1.016-1.177, p=0.003), presence of CAD (OR=2.058, 95% CI=1.122-3.777, p=0.020), resting heart rate (OR=1.041, 95% CI=1.023-1.060, p<0.001), and left atrium diameter (OR=1.049, 95% CI=1.011-1.616, p=0.002) were found to be predictors of AF. CONCLUSION: AF was higher in outpatients with HFrEF and hyponatremia. However, there is no association between sodium levels and AF in patients with HFrEF.

FUNDAMENTO: A coexistência de hiponatremia e fibrilação atrial (FA) aumenta a morbidade e mortalidade em pacientes com insuficiência cardíaca (IC). No entanto, não está estabelecido se a hiponatremia está relacionada à FA ou não. OBJETIVO: O objetivo do nosso estudo foi buscar a possível associação de hiponatremia com FA em pacientes que apresentam IC com fração de ejeção reduzida (ICFrE). MÉTODOS: Este estudo observacional, transversal e unicêntrico incluiu 280 pacientes ambulatoriais consecutivos com diagnóstico de ICFr com 40% ou menos. Com base nas concentrações de sódio ≤135 mEq/L ou superior, os pacientes foram classificados em hiponatremia (n=66) e normonatremia (n=214). Um valor de p<0,05 foi considerado significativo. RESULTADOS: A média de idade foi de 67,6±10,5 anos, 202 (72,2%) eram do sexo masculino, o nível médio de sódio no sangue foi de 138±3,6 mEq/L e a fração de ejeção média foi de 30±4%. Ao todo, 195 (69,6%) pacientes foram diagnosticados com doença arterial coronariana. A FA foi detectada em 124 (44.3%) pacientes. A taxa de FA foi maior em pacientes com hiponatremia em comparação com aqueles com normonatremia (n=39 [59,1%] vs. n=85 [39,7%), p=0,020). Na análise de regressão logística, a hiponatremia não foi relacionada à FA (OR=1.022, IC 95%=0,785­1.330, p=0,871). Idade aumentada (OR=1.046, IC 95%=1.016­1.177, p=0,003), presença de DAC (OR=2.058, IC 95%=1,122­3.777, p=0,020), frequência cardíaca em repouso (OR=1.041, IC 95%=1.023­1.060, p<0,001) e diâmetro do átrio esquerdo (OR=1.049, IC 95%=1.011­1.616, p=0,002) foram considerados preditores de FA. CONCLUSÃO: A FA foi uma taxa mais elevada em pacientes ambulatoriais com ICFr e hiponatremia. No entanto, não há associação entre os níveis de sódio e FA em pacientes com ICFrEF.

Some inflammatory markers and chest computerized tomography in patients with severe acute respiratory syndrome coronavirus infection.

OBJECTIVE: We retrospectively assessed whether there was a relationship between lung complications and some easily accessible markers to predict the presence of pulmonary consolidation in patients with coronavirus disease 2019 (COVID-19). METHODS: According to the polymerase chain reaction and chest computerized tomography results, the study was categorized into three groups. Group 1 (n=87) included the patients with polymerase chain reaction (+), group 2 (n=55) included the patients with polymerase chain reaction (-) and chest computerized tomography (+), and group 3 (n=77) included the patients with polymerase chain reaction (-) and chest computerized tomography (-), respectively. RESULTS: High-sensitivity C-reactive protein and increased age were associated with higher computerized tomography (CT) scores. CONCLUSION: Increased age and C-reactive protein (CRP) may suggest pulmonary infiltration on chest CT in patients with COVID-19.

Some inflammatory markers and chest computerized tomography in patients with severe acute respiratory syndrome coronavirus infection

SUMMARY OBJECTIVE: We retrospectively assessed whether there was a relationship between lung complications and some easily accessible markers to predict the presence of pulmonary consolidation in patients with coronavirus disease 2019 (COVID-19). METHODS: According to the polymerase chain reaction and chest computerized tomography results, the study was categorized into three groups. Group 1 (n=87) included the patients with polymerase chain reaction (+), group 2 (n=55) included the patients with polymerase chain reaction (-) and chest computerized tomography (+), and group 3 (n=77) included the patients with polymerase chain reaction (-) and chest computerized tomography (-), respectively. RESULTS: High-sensitivity C-reactive protein and increased age were associated with higher computerized tomography (CT) scores. CONCLUSION: Increased age and C-reactive protein (CRP) may suggest pulmonary infiltration on chest CT in patients with COVID-19.

Can the development of atrial fibrillation in patients with ischemic heart failure with low ejection fraction be predicted?

OBJECTIVE: Our aim is to determine the triggering factors of paroxysmal atrial fibrillation (PAF) in ischemic heart failure (HF) patients with low ejection fraction (EF). METHODS: Sixty patients were included in this study. Echocardiography and 24-hours Holter monitoring were performed after measurement of serum NT-pro BNP concentration. The patients were classified into two groups concerning the occurrence of PAF on Holter recordings. Biochemical and echocardiographic parameters of patients with and without PAF were compared. RESULTS: PAF was detected in 28 (46%) patients. Patients with PAF demonstrated higher NT-pro BNP levels, mitral and aortic regurgitation velocities, E/A, E/E', pulmonary capillary wedge pressure, pulmonary artery systolic pressure, left atrial volume and volume indices. NT-pro BNP was established as the predictor of PAF (OR=1.23, 95% CI: 1.08-1.42; p=0.001). ROC analysis showed an NT-pro BNP value of 2188 pg/mL as cut-off value with 68% sensitivity and 84% specificity [Area under the ROC curve (AUC)=0.826, CI 95%: 0.724-0.927; p<0.001]. CONCLUSION: The triggering factors for AF are increased intracardiac pressures, left atrial dilatation and increased wall tension. As an indicator of increased wall tension, elevated levels of NT-pro BNP predict the development of PAF.

Exercise and Peripheral Arteriosclerosis.

Adaptation of a healthy lifestyle including adequate daily physical activity is shown to reduce 80% of cardiovascular mortality and 40% of cancer-related deaths. A large body of evidence exists proving that this relationship is dose dependent, and even half of the recommended normal physical activity yields significant risk reduction. There has been no medical therapy that would provide such high percentages of reduction in mortality to date. The World Health Organization, therefore, has started an initiative to implement exercise into daily life as a primary prevention measure. Herein, we will focus on the effects of exercise on the vasculature, mainly the peripheral vasculature, in the context of atherosclerotic disease. Exercise has a fundamental role in the pathogenesis, diagnosis, and treatment of atherosclerotic vascular disease. It exerts a protective effect against the development of atherosclerosis irrespective of other cardiovascular risk factors. Additionally, exercise induces changes in vascular hemodynamics helping us to elucidate the presence of obscure vascular involvement. Once again, exercise is the main treatment modality in peripheral arterial disease with accumulating evidence to reduce symptoms and improve both exercise capacity and cardiovascular symptoms.

Relationship between Microfibrillar-Associated Protein 4 Levels and Subclinical Myocardial Damage in Chronic Kidney Disease.

INTRODUCTION: Chronic kidney disease (CKD) is a widespread health problem, in which mortality is most frequently due to cardiovascular diseases. Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein. MFAP4 is involved in several biological processes, particularly the maintenance of vascular integrity and extracellular matrix remodeling. Our review of the literature revealed no data concerning MFAP4 levels in CKD and its relationship with myocardial functions. OBJECTIVE: The purpose of this study was therefore to investigate MFAP4 levels in CKD, parameters affecting these, and the relationship with myocardial functions. MATERIALS AND METHODS: Seventy-nine CKD patients and 30 healthy controls were included in the study. Routine biochemical tests and echocardiography were performed once demographic data had been recorded. Blood specimens were collected for MFAP4 analysis, and the results were subjected to statistical analysis. RESULTS: MFAP4 levels were significantly higher in the patient group than in the control group (p< 0.001). Doppler parameters revealed more frequent LV diastolic impairment in the patient group. Tissue Doppler systolic velocity and global longitudinal strain were significantly impaired, revealing the subclinical LV systolic dysfunction in CKD patients. MFAP4 elevation in the patient group was positively correlated with aortic root (AR), global circumferential strain (GCS), and GCS rate. CONCLUSION: Our results showed MFAP4 elevation in CKD for the first time in the literature, and that this elevation may be related to GCS and AR dilation. We think that, once supported by further studies, MFAP4 may constitute a marker in the evaluation of myocardial functions in CKD.

The fate of small side branches following drug eluting stent implantation.

OBJECTIVES: Although drug eluting stents (DES) have documented convenience in bifurcation lesions, possible unfavorable effects on small side branch ostium (SBO) remain a question. We aimed to explore the effects of DES on small jailed SBs (1.5-2.25 mm) which originated from the lesion on the main vessel and were not treated with either stenting or balloon dilatation. METHODS: Angiographic data of 107 consecutive patients (129 SB) with Medina 1,1,1 or 1,1,0 lesions were evaluated at the time of procedure and at the follow-up. RESULTS: Of all DES used, 70 (54.7%) was sirolimus-eluting, 39 (30.5%) was paclitaxel-eluting and 20 (14.8%) was zotarolimus-eluting. The diameter of SBs was 1.84 ± 0.41 mm with a stenosis of 20.7 ± 26.6% at SBO at baseline. The lesion at the SBO had progressed after the procedure when the pre vs postprocedure values and follow-up vs pre-procedure values are compared (20.7 ± 26.6% vs 29.4 ± 27.4%; p < 0.0001 and 25.4 ± 25.1 vs 20.7 ± 26.6%; p = 0.004 respectively). A significant reduction in stenosis was revealed over the follow-up (29.4 ± 27.4 vs 25.4 ± 25.1 respectively; p = 0.013). The severity of the disease at the SBO at baseline was the only parameter that affected the severity of SB stenosis in acute, longterm and follow-up. Additional parameters with influence on SB patency at different times were female gender, stent deployment with low pressure, cTFC of the main lesion, age, cTFC of the lesion, late loss index and the preprocedure TIMI flow grade of the SB. CONCLUSIONS: Although there was a significant deterioration of SBO immediately after stenting, follow-up data showed that the lesion at SBO improved but remained worse than baseline.

Comparison of endothelial function of coronary artery bypass grafts in diabetic and nondiabetic patients: Which graft offers the best?

OBJECTIVE: Diabetes associated endothelial dysfunction, which determines both long and short term graft patency, is not uniform in all coronary artery bypass surgery (CABG) grafts. Herein this study, we aimed to investigate the degree of endothelial dysfunction in diabetic radial artery (RA), internal mammarian artery (IMA) and saphenous vein (SV) grafts in vitro tissue bath system. METHODS: This is a prospective experimental study. Fifteen diabetic and 15 non-diabetic patients were included to the study. A total number of 96 graft samples were collected; 16 graft samples for each graft type from both diabetic and non-diabetic patients. Arterial grafts were harvested with pedicles and SV grafts were harvested by 'no touch' technique. Vasodilatation response of vascular rings to carbachol, which induces nitric oxide (NO) mediated vasodilatation, was designated as the measure of endothelial function. RESULTS: The IMA grafts had the most prominent NO mediated vasodilatation in both diabetic and non-diabetic patients, concluding a better preserved endothelial function than SV and RA. The 'no- touch' SV and RA grafts had similar vasodilatation responses in non-diabetic patients. In diabetic patients, on the other hand, RA grafts exhibited the least vasodilatation response (ie. worst endothelial function), even less vasodilatation than 'no touch' SV grafts (p<0.0001). CONCLUSION: Deteriorated function of RA grafts in diabetic patients, even worse than SV grafts made evident by this study, encourages the use of 'no touch' technique as the method of SV harvesting and more meticulous imaging of RA before its use as a graft in diabetic patients.

Vasodilation Responses to Non-Selective α-Adrenergic Blockage of Coronary Bypass Grafts in Diabetic and Non-Diabetic Patients: In Vitro Study.

BACKGROUND: Adrenergic tonus is increased in atherosclerotic coronary arteries. In this study, we aimed to demonstrate in vitro effects of phentolamine, a reversible nonselective alpha (α) adrenergic blocker, on coronary artery bypass grafts (CABG) and compare its effects in diabetic and nondiabetic patients. METHODS: A total number of 30 patients (15 diabetic and 15 nondiabetic) who were assigned to elective CABG surgery were enrolled into the study. For both groups of patients, 16 internal mammarian artery (IMA) samples, 16 saphenous vein (SV) samples and 16 radial artery (RA) samples were collected and studied in the tissue bath system. The vasodilatation responses to increasing doses of phentolamine were recorded. RESULTS: When grafts were compared in terms of amount of vasodilatation to phentolamine, IMA had the most prominent vasodilatation followed by RA and SV respectively. Although the vasodilatation responses in nondiabetic patients were numerically higher than diabetic patients, there was no statistically difference between the groups. CONCLUSION: Phentolamine, a nonselective α adrenergic blocker, is proven to have equal vasodilatory effects in diabetic and nondiabetic CABG grafts and can safely be used both intravenously and topically in the perioperative period.

Risk factors for intraaortic balloon pump use in coronary artery bypass surgery.

OBJECTIVES: The study was aimed at investigating the risk factors of using an intraaortic balloon pump (IABP) in coronary artery bypass surgery and presenting the authors' clinical experience of IABP use. MATERIAL AND METHODS: The study included 1094 patients who underwent coronary artery bypass surgery at the authors' clinic between January 2009 and December 2011. A comparison was made between 17 patients in whom an IABP was used and 1077 patients in whom it was not used. RESULTS: An intraaortic balloon pump was used in 17 patients (1.55%) out of 1094 patients who underwent isolated coronary artery bypass surgery. The ratio of patients who had had preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50% and emergency surgery in Group 1 were higher than in Group 2 (p < 0.05). The total cardiopulmonary bypass time of Group 1 was found to be longer than that of Group 2 (p < 0.05). The demand for inotropics after weaning from cardiopulmonary bypass was greater in Group 1 than in Group 2 (p < 0.05). The need for reoperation (because of bleeding) was higher in Group 1 than in Group 2 (p < 0.05). The patients' stay on the intensive care unit was longer in Group 1 than in Group 2 (p < 0.05). Mortality rates were 29.4% in Group 1 and 1.2% in Group 2 (p < 0.05). CONCLUSIONS: Preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50%, emergency surgery and long cardiopulmonary bypass time are important risk factors for IABP use in coronary artery bypass surgery.

The effect of distension pressure on endothelial injury and vasodilatation response in saphenous vein grafts: conversion of a bypass graft to a dead pipe.

INTRODUCTION: Endothelial damage caused by high pressure applied for spasm relaxation during graft preparation is one of the most plausible theories explaining early graft failure. AIM OF THE STUDY: We aimed to demonstrate the extent of endothelial damage in saphenous vein grafts distended to different pressure levels by using immunohistochemical methods and in vitro tissue baths. MATERIAL AND METHODS: Saphenous vein grafts (SVGs) of 25 patients who underwent isolated elective CABG surgery were used in this study. By using a specific mechanism, SVGs were distended to five different pressure levels for two minutes: 0 mmHg, 50 mmHg, 100 mmHg, 200 mmHg, 300 mmHg. In vitro tissue baths and immunohistochemical examinations were performed. RESULTS: None of the grafts distended to 300 mmHg pressure were functional in the tissue bath system. The relaxation response to carbachol of SVGs distended to 0, 50, 100 and 200 mmHg was 97.87 ± 4.47%, 98.52 ± 3.95%, 93.78 ± 3.64%, and 30.87 ± 4.11%, respectively. There were no statistically significant differences in terms of relaxation responses between samples distended to 0, 50, and 100 mmHg (p = 0.490). The relaxation response of samples distended to 200 mmHg was significantly decreased (p = 0.021). The endothelia of samples distended to 0 mmHg were almost intact in CD31 staining. Endothelial cell loss occurred at all tested distension pressures at different degrees. CONCLUSION: In vitro and immunohistochemical studies revealed that distending an SVG used for coronary artery bypass grafting with pressures of 100 mmHg or less results in less endothelial damage and increases graft patency.

A case with double-chambered right ventricle and left ventricular-right atrial communication (Gerbode defect): potential pitfall for Eisenmenger syndrome.

The ventricular septal defect (VSD) can rarely be associated with other malformations such as double-chambered right ventricle (DCRV) in which hypertrophied muscle bundles divide the right ventricle into two chambers causing progressive obstruction (Mao et al., Asia Pac J Thorac Cardiovasc Surg 5:14-17, 1996). Most VSDs close spontaneously by apposition of the tricuspid leaflets, but the process is rarely disrupted, resulting in communication between left ventricle and right atrium called Gerbode defect [Cho et al., J Cardiovasc Ultrasound 19(3):148-151, 2011]. Hence, the Gerbode defect involves potential misinterpretation of its high-velocity shunt as pulmonary hypertension. Here we present a case with DCRV and Gerbode defect initially misdiagnosed to have Eisenmenger syndrome.