Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio.

BACKGROUND: Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. METHODS: 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). RESULTS: In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ±â€¯18.13 ml and 53.24 ±â€¯22.11 ml vs 48.85 ±â€¯12.89 ml and 42.08 ±â€¯13.85 (p = 0.037). LAVi were 20.9 ±â€¯8.91 ml/m2 and 26.85 ±â€¯11.28 ml/m2 vs 25.36 ±â€¯6.21 and 21.87 ±â€¯6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ±â€¯4.09 ng/ml and 6.02 ±â€¯2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ±â€¯1.07 103/µl and 1.98 ±â€¯0.66 103/µl (p = 0.674). CONCLUSION: LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.

Ultrasound Accelerated Thrombolysis May Be an Effective and Safe Treatment Modality for Intermediate Risk/Submassive Pulmonary Embolism.

Pulmonary embolism (PE) is a potentially life-threatening condition and the fact that 90% of PE originate from lower limb veins highlights the significance of early detection and treatment of deep vein thrombosis. Massive/high risk PE involving circulatory collapse or systemic arterial hypotension is associated with an early mortality rate of approximately 50%, in part from right ventricular (RV) failure. Intermediate risk/submassive PE, on the other hand, is defined as PE-related RV dysfunction, troponin and/or B-type natriuretic peptide elevation despite normal arterial pressure. Without prompt treatment, patients with intermediate risk PE may progress to the massive category with a potentially fatal outcome. In patients with PE and right ventricular dysfunction (RVD), in hospital mortality ranges from 5% to 17%, significantly higher than in patients without RVD.

Cardiac diastolic function is impaired at rest and worsens with exercise in otherwise healthy individuals with insulin resistance.

Insulin resistance (IR) is a pathophysiological condition and is associated with cardiovascular risk factors including heart failure. However, studies demonstrating myocardial abnormalities in the early phases of IR are limited. The aim of this study was to investigate myocardial function in otherwise healthy individuals with IR.Individuals with IR who were free of cardiovascular risk factors and healthy controls were included. Stress echocardiography with tissue Doppler imaging (TDI) was performed. Systolic and diastolic TDI waves were compared in both groups.A total of 77 individuals (51 with IR and 26 controls) were included in our study. The tissue early flow (e')/atrial contraction (a') ratio at rest was significantly lower in the IR group (P = 0.003). The annular early flow (E)/e' ratio, a predictor of left ventricular filling pressure, was similar in both groups at rest (P = 0.522). After exercise, e'/a' impairment became more prominent in the IR group (P < 0.001); whereas the E/e' ratio was also significantly lower (7.6 ± 1.8 versus 6.7 ± 0.9; P = 0.007) in the IR group.Myocardial involvement seems to occur in patients with IR, before the appearance of other cardiovascular risk factors. Exercise induced diastolic worsening may be a predictor of reduced compliance and increased ventricular stiffness. More detailed prospective studies are required for more precise results.

Mean platelet volume associated with aortic distensibility, chronic inflammation, and diabetes in patients with stable coronary artery disease.

We aimed to assess the effective factors on high mean platelet volume (MPV) in patients with stable coronary artery disease (CAD). A total of 411 patients (247 males and 164 females; mean age: 61.7 ± 9.9 years) with angiographically proven CAD were included. The patients were divided into 2 groups according to the median MPV value (MPVlow group <9.5 fL and MPVhigh group ≥9.5 fL). The SYNTAX score, high sensitive C-reactive protein (hsCRP) levels, and frequencies of diabetes and hypertension were higher in MPVhigh group compared to MPVlow group. Aortic distensibility (AD) and platelet count of patients in MPVhigh group were lower than patients in MPVlow group (P < .05, for all). Multivariate linear regression analysis showed that MPV was independently related with diabetes (ß = 0.135, P = .007), hsCRP (ß = 0.259, P < .001), platelet count (ß = -0.144, P < .001), and AD (ß = -0.425, P < .001). High MPV value is independently related to AD, as well as diabetes, hsCRP, and platelet count in patients with stable CAD.

NT-proBNP predicts impaired myocardial function in newly diagnosed hypertensive patients with preserved ejection fraction.

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent biomarker to diagnose left ventricular (LV) dysfunction. LV myocardial performance index (MPI-Tei index) is commonly used as a measure of combined systolic and diastolic function. We aimed to investigate the relationship between NT-proBNP and tissue Doppler derived MPI in newly diagnosed hypertensive patients with preserved LV ejection fraction (LVEF). We studied 236 patients with newly diagnosed HT (mean age; 52.9 ± 5.2 years). Echocardiographic examination was performed in all patients. LV mass index (LVMI) was calculated. Conventional Doppler indices (E and A waves) were recorded. The MPI value was obtained from the tissue Doppler derived ejection time, isovolumic contraction and relaxation times. The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group <114 pg/ml and NT-proBNPhigh group ≥114 pg/ml). Patients with NT-proBNPhigh were older and had higher levels of glucose and creatinine, lower E/A ratio and higher LVMI and MPI values than patients with NT-proBNPlow. However, LVEF were similar among the groups. Multiple linear regression analysis showed that NT-proBNP was independently associated with age, LVMI, MPI and E/A ratio. Increased NT-proBNP level was independently associated with impaired myocardial performance index in newly diagnosed hypertensive patients with preserved LVEF.

High-sensitivity cardiac troponin T levels in newly diagnosed hypertensive patients with different left ventricle geometry.

BACKGROUND: The high-sensitivity cardiac troponin T (hs-cTnT) assay provides important prognostic information on cardiovascular diseases. Although hs-cTnT is associated with left ventricle (LV) hypertrophy (LVH), it has not been investigated in different LV geometric patterns incorporating normal LV structure and concentric remodeling in addition to LVH. OBJECTIVES: We aimed to investigate the possible association between hs-cTnT and LV geometric patterns in newly diagnosed hypertensive patients. METHODS: We studied 306 patients with newly diagnosed hypertension (HT; mean age 51.7 ± 5.6 years) and 44 healthy control subjects (mean age 51.3 ± 4.7 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWth). hs-cTnT and other biochemical markers were measured in all participants. RESULTS: The highest hs-cTnT values were observed in the concentric hypertrophy group compared with the control, normal geometry, concentric remodeling and eccentric hypertrophy groups (p < 0.05, for all). Also, hs-cTnT values of the eccentric hypertrophy group were higher than the control, normal geometry and concentric remodeling groups (p < 0.05, for all). Multivariate regression analysis showed that hs-cTnT was independently associated with LV geometry (ß = 0.326, p = 0.001) as well as LVMI (ß = 0.228, p = 0.010) and creatinine level ß = 0.132, p = 0.012). CONCLUSION: hs-cTnT level is related not only to LVH but also to LV geometry in hypertensive patients. hs-cTnT levels may mediate poorer LV geometric patterns in hypertensive patients.

Predictors of failure of final kissing-balloon inflation after mini-crush stenting in non-left main bifurcation lesions: importance of the main-vessel angle.

BACKGROUND: The majority of bifurcation lesions are treated with crush stenting. However, the success of crush stenting depends on final kissing-balloon inflation (FKBI), which is potentially difficult. Although mini-crush stenting has a higher rate of successful FKBI, it still cannot be achieved in some patients. The aim of this study was to investigate the factors that contribute to failure of FKBI in mini-crush stenting. METHODS AND RESULTS: We included 173 consecutive patients who were treated with mini-crush stenting. The patients were divided into FKBI and non-FKBI groups. The bifurcation angles were measured: (1) proximal bifurcation angle (angle A, between proximal main vessel and side branch); (2) distal bifurcation angle (angle B, between distal main branch and side branch); and (3) the main-vessel angle (angle C, between proximal main vessel and distal main branch). FKBI could be performed in 153 patients. Angle C and calcification were significantly lower and angle A and mean stent diameter in the main vessel were significantly higher in the FKBI group. Multivariate logistic regression analysis showed that only Angle C was an independent predictor of FKBI failure. CONCLUSIONS: Main-vessel angle was the only independent predictor of FKBI failure in mini-crush stenting.

Aortic distensibility and extent and complexity of coronary artery disease in patients with stable hypertensive and nonhypertensive coronary artery disease.

OBJECTIVE: To assess the relationship between aortic distensibility (AD) and the extent and complexity of atherosclerotic lesions assessed with SYNTAX score (SS) in patients with stable coronary artery disease. SUBJECTS AND METHODS: Three hundred and seventy-six consecutive patients (230 males and 146 females; mean age: 61.6 ± 9.9 years) with angiographically proven coronary artery disease were included in the study. The SS was calculated using the SS algorithm on the baseline diagnostic angiogram in the 376 patients. AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. Frequencies of risk factors, biochemical and hematological data were recorded. The patients were divided into two groups according to the median AD value as AD(low) and AD(high) groups. RESULTS: The SS was higher in the AD(low) group compared with the AD(high) group (18.5 ± 10.2 vs. 8.3 ± 5.9, p < 0.001). The AD was independently related to age (ß = -0.104, p = 0.019), hypertension (ß = -0.202, p < 0.001) and SS (ß = -0.457, p < 0.001) and was more strongly associated with SS in hypertensive patients compared to nonhypertensive patients (r = -0.524 vs. r = -0.414, p < 0.001 for all). CONCLUSION: The findings showed that impaired AD might be an independent predictor for the severity of coronary atherosclerosis, particularly in patients with hypertension.

Coronary accordion effect mimicking coronary dissection.

The coronary "accordion" effect is a rare pseudo-complication of percutaneous coronary intervention (PCI). It is usually observed due to straightening and shortening of tortuous vessels with stiff guidewires during PCI. In this case report, we present an interesting case of the coronary accordion effect observed in a 52-year-old woman undergoing PCI.

Relation of mitral annular dilation with dynamic mitral regurgitation in patients with rheumatic mitral regurgitation.

INTRODUCTION: Dynamic mitral regurgitation (MR) is frequently investigated in patients with left ventricular systolic dysfunction (LVSD). Data about the dynamic MR in patients with organic valve disease are limited. The aim of this study was to evaluate the alteration of MR by exercise in patients with rheumatic valve disease (RVD). METHODS: Asymptomatic patients with rheumatic MR and normal left ventricular function had been included in our study. Transthoracic echocardiography and Doppler measurements were performed at rest and just after submaximal exercise test performed with treadmill. Severity of MR was evaluated quantitatively by measuring effective regurgitant orifice area (EROA) with flow convergence method. RESULTS: A total of 34 patients with rheumatic MR had been included. Severity of MR increased in 10 patients with exercise (Group 1) and decreased in 24 of them (Group 2). When the variables of two groups were compared; diastolic blood pressure after exercise, EROA, left atrial volume, left ventricular diastolic volume and mitral annular area values were significantly higher in Group 1 patients. A linear regression model was constructed by considering change of EROA by exercise the dependent, and the variables showing significant differences as the independents. Mitral annular area was found to be independently associated with EROA increase with exercise (R(2) = 0.499; P < 0.001). CONCLUSION: Mitral annular dilation is independently associated with increase of MR with submaximal exercise in asymptomatic patients with MR due to RVD with normal left ventricular function.

The distribution of circulating microRNA and their relation to coronary disease.

BACKGROUND: MicroRNAs (miRNAs) are small RNAs that regulate gene expression by suppressing protein translation and may influence RNA expression. MicroRNAs are detected in extracellular locations such as plasma; however, the extent of miRNA expression in plasma its relation to cardiovascular disease is not clear and many clinical studies have utilized array-based platforms with poor reproducibility. METHODS AND RESULTS: Initially, to define distribution of miRNA in human blood; whole blood, platelets, mononuclear cells, plasma, and serum from 5 normal individuals were screened for 852 miRNAs using high-throughput micro-fluidic quantitative RT-PCR (qRT-PCR). In total; 609, 448, 658, 147, and 178 miRNAs were found to be expressed in moderate to high levels in whole blood, platelets, mononuclear cells, plasma, and serum, respectively, with some miRNAs uniquely expressed. To determine the cardiovascular relevance of blood miRNA expression, plasma miRNA (n=852) levels were measured in 83 patients presenting for cardiac catheterization. Eight plasma miRNAs were found to have over 2-fold increased expression in patients with significant coronary disease (≥70% stenosis) as compared to those with minimal coronary disease (less than 70% stenosis) or normal coronary arteries. Expression of miR-494, miR-490-3p, and miR-769-3p were found to have significantly different levels of expression. Using a multivariable regression model including cardiovascular risk factors and medications, hsa-miR-769-3p was found to be significantly correlated with the presence of significant coronary atherosclerosis. CONCLUSIONS: This study utilized a superior high-throughput qRT-PCR based method and found that miRNAs are found to be widely expressed in human blood with differences expressed between cellular and extracellular fractions. Importantly, specific miRNAs from circulating plasma are associated with the presence of significant coronary disease.