Association between Systolic Pulmonary Artery Pressure and Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction.

Introduction: The objective of this study was to examine whether there is an elevated risk of developing contrast induced nephropathy (CIN) in patients with high systolic pulmonary artery pressure (SPAP) in ST-segment elevation myocardial infarction (STEMI). Methods: A total of 213 patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention were enrolled in the study. The patients were stratified into two groups based on the presence of CIN. Comparisons between these groups included an assessment of demographic characteristics, laboratory findings, and risk factors. SPAP was calculated for each patient upon admission through echocardiography, and subsequent comparisons were performed between the groups. Results: The distribution of the study population was as follows: 33 (15.5%) were CIN(+) and 180 (84.5%) were CIN(-). SPAP [odds ratio (OR) = 1.295, 95% confidence interval (CI): 1.157-1.451, p < 0.001], and diabetes (OR = 1.241, 95% CI: 1.194-1.287, p = 0.013) were identified as independent factors associated with CIN development. In receiver operating characteristic curve analysis, SPAP above a cut-off level of 31.5 mmHg could determine the presence of CIN with a sensitivity of 91.0% and specificity of 90.0% (p < 0.001). Conclusions: SPAP on echocardiography is an independent predictor of the development of CIN in patients with STEMI. Its ease of calculation renders it a valuable tool for predicting CIN among STEMI patients.

Multiple congenital ventricular diverticula causing heart failure.

This paper reports a case of multiple congenital ventricular diverticula, a rare anomaly that is associated with heart failure.

Comparison of secondary prevention in coronary heart disease patients living in rural and urban areas.

OBJECTIVE: The aim of the present study was to assess differences between urban and rural patients with coronary heart disease (CHD) with respect to secondary prevention. METHODS: This cross-sectional study included all consecutive patients diagnosed with CHD at 2 cardiology clinics between January 2016 and January 2017. The demographic characteristics and laboratory parameters were recorded at routine control visits. The patients were divided into 2 groups according to residence based on their statements: urban (n=1752) and rural (n=456). RESULTS: The median age of the patients was 64 years (interquartile range: 12 years). A mean of 4.1+-2.1 years had passed after the first (index) coronary event. It was determined that 22.2% of the patients continued to smoke. The rate of quitting was significantly higher in the urban group (20.5% vs. 11.2%; p<0.001). The presence of hypertension (64.3% vs. 56.7%), diabetes mellitus (45.6% vs. 39.2%), cerebrovascular events (9.2% vs. 3.8%), and chronic obstructive pulmonary disease (11.4% vs. 5.5%) was significantly greater among the rural patients (p<0.05 for each). In all, 34.2% were obese, and the number of obese patients was significantly greater among the rural patients (46.4% vs. 31.2%; p<0.001). The number of patients performing regular exercise was significantly lower in the rural patient group (34.4% vs. 23.9%; p<0.001). Overall, 88.9% of the patients were taking antiplatelet agents, 62.1% were taking statins, 73.1% were taking beta-blockers, and 34.2% were taking ACEI/ARB. The rate of medication use was significantly greater among urban patients compared with rural patients (p<0.05 in all cases). CONCLUSION: Secondary prevention efforts among patients with CHD require additional improvement. Moreover, secondary prevention is currently less successful among the rural population than the urban population.

Prediction of subtle left ventricular systolic dysfunction in homozygous and heterozygous familial hypercholesterolemia: Genetic analyses and speckle tracking echocardiography study.

BACKGROUND AND AIMS: Few studies have shown the direct effect of familial hypercholesterolemia (FH) on myocardial systolic function. Studies focused on heterozygote FH patients but not homozygote ones, and they did not perform genetic analyses. We aimed to evaluate all types of patients with FH using the potentially more sensitive speckle tracking echocardiography (STE) technique to identify early left ventricular (LV) dysfunction. METHODS: Genetic analyses of patients with FH were conducted for LDL-receptor, PCSK9, and ApoB100. Nine homozygote, two compound heterozygote, and 82 heterozygote FH patients and 85 healthy subjects were prospectively studied. Longitudinal and circumferential strain measurements and conventional echocardiography findings were obtained. RESULTS: LV ejection fractions were similar for all (homozygote, heterozygote, and control) groups. The LV average longitudinal strain (aLS) and average circumferential strain (aCS) levels were significantly reduced in the homozygote and heterozygote groups when compared with the controls (for aLS, P = .008 (<.001); for aCS, P =< .001). A significant inverse correlation was found between LDL-C levels and LS (P < .001, r = .728) and CS (P < .001, r = .642) for all FH patients. CONCLUSIONS: This study demonstrates the potential of using systolic strain values obtained using 2D STE for determining lipotoxicity in the myocardium owing to hypercholesterolemia. Our study found that cardiac functions of homozygote patients who had the highest cholesterol levels were disrupted at very early ages. Therefore, starting lipid reduction treatment and early reverse LV remodelling therapy at early ages may be beneficial for high-risk patients.

The effect of acute allergic reactions on diastolic heart function.

PURPOSE: Diastolic heart failure is characterized by the presence of heart failure symptoms despite preserved systolic function. Cytokines released during allergic reactions may impair diastolic heart function, either through their direct toxic effects or by inducing coronary artery spasm. The purpose of this study was to examine the effects of acute allergic reactions on diastolic heart function. METHODS: Fifty patients, randomly selected from those who were admitted to the emergency room between May 2010 and December 2010 with the complaints of rash and itching, and who were subsequently diagnosed with allergic reactions based on the clinical and laboratory findings, were included in the study as the allergy group. Thirty healthy volunteers, in whom the diagnosis of allergy was ruled out based on the clinical and laboratory data, were use as the control group. Diastolic heart functions were evaluated in patients presenting with allergic reaction as well as in control subjects. RESULTS: There was no significant difference between the two groups in terms of basal systolic functions, diameters of the cavities and wall thicknesses, and biochemical parameters. Color M mode flow progression velocities, E ratios, E/A ratios and mitral lateral annulus tissue Doppler velocities measured by echocardiography at Day 0 and Day 5 were significantly altered in the allergy group (p < 0.05). CONCLUSION: Impairment in diastolic functions was observed following acute allergic reactions. Acute allergic reactions could be a cause of mortality and morbidity if they lead to the development of diastolic heart failure.

Effects of high loading dose of clopidogrel in ST elevated myocardial infarction treated with fibrinolytic agent.

PURPOSE: The purpose of the present study was to evaluate the effects of different loading doses of clopidogrel on ST segment resolution on ECG, changes in cardiac enzyme levels and serum levels of high-sensitivity C-reactive protein (Hs-CRP) in patients with ST elevated myocardial infarction (STEMI) treated with fibrinolytic therapy. METHODS: Patients admitted to our cardiology clinic with a diagnosis of STEMI and treated with fibrinolytic therapy were included: Group 1 (n=58) received a 300 mg loading dose of clopidogrel, Group 2 (n=55) a 450 mg loading dose and Group 3 (n=59) a 600 mg loading dose. A 75 mg/d maintanence dose of clopidogrel was given in all groups. RESULTS: All demographic characteristics and baseline laboratory parameters were statistically similar among three groups (p > 0.05). When ST resolution periods were compared, most patients in Group 3 had ST resolution at 30 minutes; Group 2 at 60 minutes and Group 1 at 90 minutes (p < 0.05). Peak levels of creatine kinase (CK) and CK-MB were as follows: Group 3, 8(th) hour, Group 1 and 2, 12(th) hour. Peak levels of those enzymes were significantly lower in Group 3 than in Group 1 and 2 ( < 0.05). Although basal hs-CRP levels of all groups were similar, the increase in hs-CRP levels at 48 hours was lower with higher clopidogrel loading doses (p < 0.05). CONCLUSION: In this study comparing three different clopidogrel loading doses, the higher doses provided earlier ECG resolution, earlier and lower peak CK and CK-MB levels and lower levels of hs-CRP.