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Abstract Background Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities. Objective Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Methods 127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were evaluated as well as baseline demographic and clinical parameters. Kruskal-Wallis one-way ANOVA test was used for comparing quantitative variables with abnormal distribution while One-Way ANOVA test was used for comparing the means between groups with normal distribution. Tukey HSD and Welch tests were used for subgroups analyses with normal distribution. Spearman analysis was used to evaluate the correlation between clinical variables and repolarization markers. A p-value < 0.05 was considered statistically significant. Results Tp-e interval [66(50-83), 71(59-82) and 76(64-86); group 1,2 and 3 respectively, p<0.001], Tp-e/QT (0.170.02, 0.180.01 and 0,190.01; group 1,2 and 3 respectively, p<0.001) and Tp-e/QTc (0.150.02, 0.160.02 and 0.170.02; group 1,2 and 3 respectively, p<0.001) ratios were found to be associated with increased level of CAD spectrum. Syntax score was positively correlated with Tp-e interval (r=0.514, p<0.001), Tp-e/QT (r=0.407, p<0.001), and Tp-e/QTc ratios (r=0.240, p<0.001). Conclusion Prolonged Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratios were detected in the presence of CAD and especially in patients with acute ischemic syndromes. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico , Electrocardiografía/métodos , Síndrome Coronario Agudo/diagnóstico , Arritmias Cardíacas , Valores de Referencia , Estudios TransversalesRESUMEN
OBJECTIVE: Coronary slow-flow phenomenon (CSFP) is defined as the delayed arrival of coronary blood flow to the distal vascular bed in at least 1 major epicardial coronary artery. Cell-free DNA (cfDNA) is a type of DNA that circulates freely in the blood once released from nucleated cells. The aim of this study was to determine if the level of cfDNA, which is an indicator of ischemia at the cellular level, was increased in CSFP. METHODS: The study included 46 patients in total: 23 patients with CSFP and 23 with a normal coronary angiogram (NCA). The level of cfDNA, and clinical, biochemical, and angiographic features of the groups were compared. RESULTS: The mean age was 53.8±10.3 years for the CSFP patient group and 56.6±9.4 years for the NCA patient group. There was no statistically significant difference between the groups in terms of basal clinical characteristics or laboratory data. The plasma cfDNA level was 5.04±2.37 ng/µL in the CSFP patients and 2.28±1.09 ng/µL in the NCA group (p<0.001). CONCLUSION: Several invasive and noninvasive studies conducted on patients with CSFP have revealed myocardial ischemia. The results of this study demonstrated that the level of cfDNA was significantly increased in patients with CSFP as a result of ischemia at the cellular level caused by microvascular disruption.
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Ácidos Nucleicos Libres de Células/sangre , Vasos Coronarios/patología , Isquemia/genética , Fenómeno de no Reflujo/fisiopatología , Adulto , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Angiografía Coronaria/métodos , Vasos Coronarios/metabolismo , Vasos Coronarios/fisiopatología , Estudios Transversales , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Isquemia/metabolismo , Isquemia/fisiopatología , Masculino , Microvasos/fisiopatología , Persona de Mediana Edad , Isquemia Miocárdica/fisiopatología , Fenómeno de no Reflujo/diagnóstico por imagen , Estudios ProspectivosRESUMEN
Following percutaneous vertebroplasty for vertebral compression fracture 6 years prior, late pulmonary cement embolism developed after leakage of the cement into the paravertebral venous plexus.
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Cementos para Huesos/uso terapéutico , Cementoplastia/efectos adversos , Embolia , Efectos Adversos a Largo Plazo , Complicaciones Posoperatorias , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas , Venas/diagnóstico por imagen , Anciano , Técnicas de Imagen Cardíaca , Cementoplastia/métodos , Embolia/diagnóstico , Embolia/etiología , Femenino , Fracturas por Compresión/cirugía , Humanos , Hallazgos Incidentales , Efectos Adversos a Largo Plazo/diagnóstico , Efectos Adversos a Largo Plazo/etiología , Polimetil Metacrilato/uso terapéutico , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Vértebras Torácicas/irrigación sanguínea , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugíaRESUMEN
OBJECTIVE: To compare surgical risk scores including Euroscore II, STS and Logistic Euroscore for their predictive ability about postoperative atrial fibrillation (POAF). STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital and Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, from June to December 2018. METHODOLOGY: One hundred and four patients, undergoing isolated coronary artery bypass grafting operation, were enrolled. Surgical risk scores, clinical, laboratory and echocardiographic parameters were compared between POAF-positive and POAF-negative groups Results: Of the 104 patients included, 23 (22.1%) patients developed atrial fibrillation postoperatively. Peripheral artery disease, carotid artery disease, current smoking, cardiopulmonary bypass time, left atrial diameter, and Syntax II score were found to be associated with POAF. Among these, peripheral artery disease and cardiopulmonary bypass time were independently related with POAF. Euroscore II (p = 0.005), STS (p = 0.026) and Logistic Euroscore (p = 0.032) were all statistically higher in POAF developing patients. In terms of ROC analysis, area under the curve was higher in Euroscore II (0.697) than STS and Logistic Euroscore (0.658 and 0.652, respectively). CONCLUSION: Euroscore II, STS and Logistic Euroscore were all associated with POAF development. However, Euroscore II could be a better option for the prediction of POAF.
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Fibrilación Atrial/epidemiología , Puente de Arteria Coronaria , Complicaciones Posoperatorias/epidemiología , Medición de Riesgo , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Turquía/epidemiologíaAsunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Esclerosis Calcificante de la Media de Monckeberg/patología , Arteria Radial/patología , Vena Safena/trasplante , Anciano , Puente Cardiopulmonar , Toma de Decisiones Clínicas , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Humanos , Masculino , Esclerosis Calcificante de la Media de Monckeberg/complicaciones , Recolección de Tejidos y Órganos , Resultado del TratamientoAsunto(s)
Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Arritmias Cardíacas/prevención & control , Arritmias Cardíacas/fisiopatología , Electrocardiografía , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Biomarcadores/sangre , Estudios Transversales , Ecocardiografía , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Introduction-patients: Takayasu arteritis may involve various parts of the aorta and its major branches. It leads to occlusive or aneurysmal disease of the vessel. It can be treated either with surgery or percutaneous intervention. We report a successful endovascular treatment of stenosis of the descending thoracic and abdominal aorta in a 19-year-old female. Methods-results-conclusions: Self-expandable nitinol stent was deployed and adequate opening of the aorta was obtained in this patient. Long-term durability of endovascular approach is a matter of debate. We also reviewed the sufficiency of endovascular treatment versus surgery.
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Aleaciones , Aorta Abdominal , Aorta Torácica , Arteriopatías Oclusivas/cirugía , Procedimientos Endovasculares/métodos , Stents Metálicos Autoexpandibles , Arteritis de Takayasu/complicaciones , Aortografía , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/etiología , Femenino , Humanos , Diseño de Prótesis , Síndrome , Arteritis de Takayasu/diagnóstico , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: Early cessation of dual antiplatelet therapy (DAPT) is related to stent thrombosis (ST). The use of second-generation everolimus- and zotarolimus-eluting stents is associated with low restenosis rates and short duration of clopidogrel usage. Non-cardiac surgery in recently stent-implanted patients is associated with major adverse cardiac events (MACEs). Chronic renal failure patients awaiting renal transplantation may also undergo coronary stent implantation prior to surgery. Here we aimed to investigate the safety of early (3 months) DAPT interruption in second-generation drug-eluting stent (DES)-implanted renal transplant recipients. METHODS: In total, 106 previously stent-implanted chronic renal failure patients who underwent renal transplantation were retrospectively enrolled. Three groups were formed according to stent type and the duration of DAPT: early-interruption (3 months from DES implantation), lateinterruption (3-12 months from DES implantation), and bare-metal stent (BMS; at least 1 month from BMS implantation) groups. RESULTS: Comparison among BMS, DES-early and DES-late groups indicated no difference in ST, myocardial infarction, death, and MACEs. In addition, no difference was observed in ST (p=0.998), myocardial infarction (p=0.998), death (p=0.999), and MACEs (p=0.998) between DES-early and DES-late groups. CONCLUSION: Early (3 months) interruption of antiplatelet treatment with second-generation stents before renal transplantation seems to be safe and does not lead to increase in the occurrence of ST and MACEs.
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Clopidogrel/administración & dosificación , Stents Liberadores de Fármacos , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Inhibidores de Agregación Plaquetaria/administración & dosificación , Clopidogrel/efectos adversos , Esquema de Medicación , Everolimus , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/efectos adversos , Periodo Preoperatorio , Estudios Retrospectivos , Sirolimus/análogos & derivados , Trombosis/prevención & controlAsunto(s)
Válvula Aórtica , Enfermedades de las Válvulas Cardíacas/complicaciones , Infarto del Miocardio con Elevación del ST/etiología , Seno Aórtico , Trombosis/complicaciones , Válvula Aórtica/diagnóstico por imagen , Aortografía , Biopsia , Puente de Arteria Coronaria , Resultado Fatal , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/cirugía , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugía , Trombectomía , Trombosis/diagnóstico por imagen , Trombosis/cirugía , Resultado del TratamientoAsunto(s)
Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Adulto , Angiografía Coronaria , Diagnóstico Diferencial , Disnea/etiología , Ecocardiografía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Humanos , Masculino , Mixoma/complicaciones , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Grabación en VideoAsunto(s)
Plaquetas , Clopidogrel , Humanos , Inhibidores de Agregación Plaquetaria , Pronóstico , Factores de RiesgoAsunto(s)
Infarto del Miocardio/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/efectos adversos , Púrpura Trombocitopénica Trombótica/diagnóstico , Ticagrelor/efectos adversos , Adulto , Dolor en el Pecho/etiología , Angiografía Coronaria , Diagnóstico Diferencial , Stents Liberadores de Fármacos , Humanos , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Púrpura Trombocitopénica Trombótica/inducido químicamenteRESUMEN
INTRODUCTION: The aim of the study was to assess whether a cardiac troponin T (cTnT) level 1 ng/ml or below threshold is safe and to evaluate mid-term follow-up results in stable patients with non-ST-segment elevation after acute myocardial infarction. MATERIAL AND METHODS: Among cTnT positive patients who presented to the emergency unit with chest pain and received coronary angiography, 100 patients who underwent isolated coronary artery bypass grafting (CABG) constituted the study group (group 1). The same number of patients (n = 100) who were cTnT negative and underwent an isolated CABG operation under elective conditions were selected as the control group (group 2). RESULTS: Among preoperative criteria, group 1 had significantly higher smoking rates (74% vs. 41%, p = 0.0001), and significantly lower ejection fraction values (47.1 ±8.25, 54.69 ±8.73, p = 0.0001). There were no significant differences between the groups with respect to operative parameters. Postoperative follow-up periods were significantly longer in group 1 (23.25 ±14 vs. 17.55 ±7.95 months, p = 0.001). Average waiting time for cTnT to drop below the 1 ng/ml threshold value was 5.73 ±2.95 (1-12) days. Intra-aortic balloon pump use in Groups 1 and 2 was 3% and 1%, respectively. There were no hospital mortalities in either group. Mortality rates at mid term were 6% in both groups. CONCLUSIONS: This study compared two groups positive and negative for preoperative cTnT. The findings show that it is safe to wait until cTnT levels decrease to the 1 ng/ml threshold value in cTnT positive patients having a stable course. This waiting period is not very long, which is significant with respect to potential complications.
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OBJECTIVE: To report a case of ventricular fibrillation caused by severe hypokalemia probably associated with sertraline use. CASE SUMMARY: A 48-year-old male patient experienced ventricular fibrillation and cardiac arrest 2 hours after an uneventful coronary angiography procedure, which revealed normal, unobstructed coronary arteries. Blood chemistry was immediately obtained, revealing a very low potassium (K+) level of 2.44 mEq/L. Other blood electrolytes, including magnesium, ECG, and corrected QT intervals, were all within normal limits. A thorough search for an etiology of hypokalemia, including adrenal gland causes, herbal product consumption, and toxic exposure, did not reveal any identifiable cause. This led us to consider the only drug he was on--sertraline 50 mg per day--as the possible culprit. DISCUSSION: There has been no clear identification of severe hypokalemia associated with sertraline use in the literature. However, there have been a considerable number of self-reported cases of hypokalemia in patients on sertraline therapy. Scoring according to the Naranjo adverse drug reaction scale revealed a probable relationship between severe hypokalemia and sertraline use in our patient. No clear pathogenic mechanism for the effect of sertraline on serum K equilibrium is known. However, considering the number of self-reported incidences and this case report, the effect of sertraline on serum K levels warrants consideration. CONCLUSIONS: This is the first documented case report of severe hypokalemia probably associated with sertraline use.
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Antidepresivos/efectos adversos , Hipopotasemia/inducido químicamente , Sertralina/efectos adversos , Paro Cardíaco/sangre , Paro Cardíaco/etiología , Humanos , Hipopotasemia/sangre , Hipopotasemia/complicaciones , Masculino , Persona de Mediana Edad , Potasio/sangre , Fibrilación Ventricular/sangre , Fibrilación Ventricular/etiologíaAsunto(s)
Síndrome Coronario Agudo/diagnóstico por imagen , Aneurisma Falso/diagnóstico por imagen , Aorta Torácica , Puente de Arteria Coronaria/métodos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/cirugía , Adulto , Aneurisma Falso/diagnóstico , Aneurisma Falso/cirugía , Implantación de Prótesis Vascular/métodos , Terapia Combinada , Angiografía Coronaria/métodos , Diagnóstico Diferencial , Humanos , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoAsunto(s)
Hemorragias Intracraneales/inducido químicamente , Infarto del Miocardio/terapia , Terapia Trombolítica/efectos adversos , Rotura Septal Ventricular/etiología , Factores de Edad , Anciano , Hemodinámica , Humanos , Hemorragias Intracraneales/fisiopatología , Hemorragias Intracraneales/terapia , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Resultado del Tratamiento , Rotura Septal Ventricular/fisiopatología , Rotura Septal Ventricular/terapiaRESUMEN
Many epidemiological studies have reported an association between hemostatic factors and risk of both coronary and peripheral artery diseases. Using polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis, we investigated the association between coronary artery disease and polymorphisms in the methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), prothrombin (G20210A), and factor V (A4070G) genes. We screened these gene variants in 174 subjects who had undergone coronary angiography - 115 patients with patent coronary artery disease (grade 3 vessel disease, i.e., significant coronary stenosis), and 59 healthy controls with grade 0 vessel disease. The analysis of our data did not show any statistically significant association between coronary artery disease (CAD) and the investigated polymorphisms.