Increased epicardial fat thickness is related with body mass index in women with polycystic ovary syndrome.

AIM: We aimed to investigate the relationship between PCOS and epicardial fat thickness with transthoracic echocardiography. PATIENTS AND METHODS: PCOS patients were divided into two groups according to the lean or obesity status: PCOS patients with lean 34 subjects (BMI: 23.3±2.8; mean age: 25.5±4), PCOS patients with obese16 subjects (BMI: 32.3±7.6; mean age: 27.2±3.7) were compared with control healthy lean subjects (BMI: 23.5±1.7; mean age: 25.9±2.2). RESULTS: There was increased epicardial thickness in obese PCOS subjects compared to lean PCOS subjects (6.3±0.9 mm, 4.7±0.5, respectively, p < 0.001). However, epicardial fat thickness between lean PCOS subjects and lean healthy control groups were not significantly varied (4.7±0.5 mm, 4.5±0.5, respectively, p = 0.6). There was increased epicardial thickness in obese PCOS subjects compared to lean healthy control subjects (6.3±0.9 mm, 4.5±0.5, respectively, p < 0.001). This sudy showed for the first time that increased epicardial fat thickness measured using transthoracic echocardiography is associated with increased BMI in PCOS subjects. CONCLUSIONS: Epicardial fat thickness between lean PCOS subjects and lean healty control group were similar which indicate the importance of obesity in PCOS subjects.

Effect of hypoglycemic drugs on aspirin resistance in patients with diabetes mellitus.

BACKGROUND: Aspirin reduces the odds of an arterial thrombotic event in high-risk patients. However, 10%-20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term followup. Aspirin resistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, percutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and diabetes mellitus (DM). The aim of this study was to assess aspirin resistance and to compare it to the use of oral anti-diabetic drugs and insulin in patients with diabetes. METHODS AND RESULTS: Platelet aggregation was measured after aspirin treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two patient populations were included in the investigation: use of insulin (group 1) and use of oral anti-diabetic agents (OAD) (group 2) in diabetic patients. Platelet aggregation was determined using a multichannel Multiplate analyzer. Among group 1 patients, 4.7% were aspirin non-responders and among group 2 patients, 8.6% were aspirin non-responders. Statistical differences were not found between the groups (p = 0.359). CONCLUSIONS: This study demonstrated that there was no significant difference in aspirin resistance between type 2 diabetes mellitus patients on insulin treatment and type 2 diabetes mellitus patients on OAD treatment.

Implantable cardioverter defibrillator pocket infection caused by Klebsiella pneumonia.

Like any other foreign bodies, implanted cardiac devices can become infected. Staphylococcus aureus and coagulase-negative Staphilococci are the most common causes of infections of pacemaker and defibrillator systems. In this case an implantable cardioverter defibrillator pocket infection caused by an extremely rare microorganism, Klebsiella pneumonia, is presented.

Duplex sonography of the carotid arteries in patients with pure aortic regurgitation: pulse waveform and hemodynamic changes and a new indicator of the severity of aortic regurgitation.

PURPOSE: To determine the changes of multiple hemodynamic parameters and pulse wave contour in pure aortic regurgitation (AR) and to present a new indicator of the severity of AR (shrink ratio of proximal common carotid artery). MATERIAL AND METHODS: The sonograms of 42 patients (31 M, 11 F; 16-68 years) with pure AR and 18 control subjects (15 M, 3 F; 20-47 years) were assessed for velocities and indices, and change of pulse wave contour (bisferious pattern, zero level and retrograde diastolic flow) in each carotid artery. Shrink ratio (maximum diameter-minimum diameter/maximum diameter) of each proximal common carotid artery was calculated. RESULTS: Bisferious waveforms seen in patients with AR grade 1, grade 2, and grade 3-4 were 66%, 83%, and 88%, respectively. Diastolic reversed flow was determined in 7 (39%) of 18 patients with AR grade 3-4. Three patients (25%) with AR grade 2 and 4 patients (22%) with AR grade 3-4 had zero level diastolic flow in the common carotid artery. Statistically significant changes of decreased end-diastolic velocity, increased peak systolic velocity/end-diastolic velocity, resistivity index, and pulsatility index were revealed, especially in AR grade 3-4 compared to controls. Significantly increased shrink ratio was seen only in AR grade 3-4. CONCLUSION: Increased shrink ratio or changes in hemodynamics or pulse waveform can be used in recognition of AR.

Phaeochromocytoma-induced myocarditis mimicking acute myocardial infarction.

A 44-year-old woman presented with sudden onset of chest pain, headache and nausea. Physical examination was remarkable for mild hypotension and tachycardia. ECG demonstrated sinus tachycardia with poor R wave progression in precordial leads and T wave inversion in leads V1-3. Cardiac enzymes were raised. Echocardiographic examination revealed normal cavity diameters with basal and mid left ventricular hypokinesia and an ejection fraction of 45%. A diagnosis of non-ST elevation myocardial infarction was made. A few orthostatic hypotensive attacks occurred at follow-up. A coronary angiogram showed normal coronary arteries. Within a few days, the echocardiographic findings, ECG and all cardiac markers had returned to normal. Two months later she presented with headache, palpitation, fever, neck swelling, flushing and hypertensive attacks. Phaeochromocytoma was diagnosed on the basis of increased metanephrine on urinalysis and a left suprarenal mass on CT scan.

Incessant monomorphic ventricular tachycardia during febrile illness in a patient with Brugada syndrome: fatal electrical storm.

A 55-year-old male with structurally normal heart presented with sustained monomorphic ventricular tachycardia (VT) and was cardioverted into sinus rhythm revealing a right bundle branch block pattern at baseline electrocardiography. Sustained monomorphic and nonsustained polymorphic VT were reproducibly inducible during electrophysiological study. During the diagnostic workup, the patient experienced fever due to hospital based pneumonia, which unmasked typical ST segment changes of Brugada syndrome. In the intensive care unit, fever became intractable leading to incessant monomorphic VT, which was resistant to all medical manoeuvers resulting in the patient's death.

Resolution of a spontaneous coronary artery thrombus with a new antiplatelet agent.

A thrombus was observed in the left anterior descending coronary artery in a 47 year-old woman who presented with acute anterior myocardial infarction. On a coronary angiogram in the right oblique cranial position, the thrombus appeared as an eccentric, solid and homogeneous mass with a 22 mm maximal length and 1.9 mm maximal diameter. The thrombotic segment and the rest of the coronary tree was free of atherosclerosis. Due to the inappropriate coronary structure and length of the thrombus, coronary angioplasty and/or stent procedures were not performed. The patient refused coronary artery by-pass. She was given the glycoprotein IIb/IIIa inhibitor tirofiban 0.4 microg x kg(-1) x min(-1) bolus over 30 minutes followed by 0.1 microg x kg(-1) x min(-1) for 24 hours, orally acetylsalicylic acid 300 mg per day, nytroglicerin 40 mg per day and warfarine with INR being in a range of 2-2.5 times. A control coronary angiography performed two months later showed total dissolution of the coronary thrombus and clearance of the culprit vessel.