Screening of coronary artery anomalies in 11,707 patients reveals that the radial approach is safe for cannulating coronary anomalies.

OBJECTIVE: This study evaluated the transradial approach for its ability to diagnose coronary artery anomalies, its requirement for catheter usage, the number of images obtained and fluoroscopy time required. PATIENTS AND METHODS: A total of 11,707 patients' coronary angiograph reports from January 2009 to January 2016 were evaluated with 179 patients identified as having coronary artery anomalies. Subsequent analyses compared patients' access sites with multiple angiographic parameters, including the number of images obtained, catheters used, and the fluoroscopy time required. RESULTSesults: The frequency of coronary artery anomalies identified by angiographies was 0.015%. Coronary anomalies were detected by transradial access (TRA) in 133 patients and by transfemoral access (TFA) in 46 patients. The most common anomaly was in the right coronary artery originating from the left sinus Valsalva (71 patients; 39.2%). The fluoroscopy times required and the number of catheters used was similar between the TRA and TFA groups (p = 0.887 and 0.302, respectively) while the number of images obtained during coronary angiographies was higher in the TFA group (p = 0.021). CONCLUSIONS: TRA is safe and effective for cannulation and the diagnosis of congenital coronary artery anomalies.

Relationship between fluid status as assessed by bioimpedance analysis and NT-pro BNP, blood pressure and left ventricular mass index in hemodialysis patients.

AIMS: Maintenance of fluid status within an optimal range and accurate assessment of dry weight (DW) is essential in patients on intermittent haemodialysis (HD) treatment. In this study, we aimed to investigate the association of fluid status measured by bioimpedance analysis (BIA) with N-terminal pro-B natriuretic peptide (NT-proBNP), blood pressure and left ventricular mass index (LVMI) in hemodialysis patients. MATERIALS AND METHODS: A total of 45 hemodialysis patients were enrolled in the study. N-terminal pro-B natriuretic peptide (NT-proBNP) was measured by immunoassay. Blood pressure (BP) was recorded. Echocardiographic examinations were performed in all patients. Multifrequency bioimpedance analysis was used to assess pre- and post-dialysis fluid status. Overhydration/ extracellular water (OH/ECW) ratio was used as fluid status index and OH/ECW ratio >0.15 was defined as clinical overhydration. Patients were divided into two groups; overhydrated (OH/ECW>0.15) and non-overhydrated (OH/ECW≤0.15). RESULTS: OH/ECW, systolic blood pressure (SBP), diastolic blood pressure (DBP), LVMI and NT-proBNP levels were significanly reduced after hemodialysis session. The presence of overhydration was more frequent in pre-HD patients compared to post-HD patients (31.1% vs 13.3%, p=0.004). OH/ECW was positively correlated with pre-and post-HD SBP, DBP, LVMI and NT-proBNP (p<0.05). Overhydrated patients had significantly higher values of pre-HD and post-HD SBP, DBP, LVMI and NT-proBNP compared to non-overhydrated patients. In addition, SBP, DBP, LVMI and NT-proBNP levels were significantly reduced after hemodialysis in both overhydrated and non-overhydrated patients group. CONCLUSIONS: This study revealed that OH/ECW ratio was significantly associated with SBP, DBP, LVMI and NT-proBNP.

The association between mean platelet volume and coronary collateral circulation.

BACKGROUND: Platelets are important in the pathogenesis of atherosclerotic complications. Higher mean platelet volume (MPV) levels are related to greater in vitro aggregation, and have been identified as an independent risk factor for myocardial infarction, and for death or recurrent vascular events. AIM: To determine the relationship between MPV and the coronary collateral circulation. METHODS: The sample consisted of 96 patients with coronary artery disease, and patients were separated into two groups according to their poorly developed or well-developed collateral circulation. Coronary collateral vessels were analyzed according to the Cohen and Rentrop grading system of 0-3. RESULTS: All analyses were conducted using SPSS 11.5 (SPSS for Windows 11.5, Chicago, IL, USA). Continuous variables were expressed as mean ± SD, and categorical variables were expressed as percentages. Comparison of categorical and continuous variables between the group with well-developed coronary collateral vessels and the group with poorly developed vessels was performed using the chi-squared test and independent samples t-test, respectively. Platelet count and MPV values were similar between the two groups. CONCLUSIONS: Our study found that MPV levels are not related to coronary collateral circulation.  

The effect of glucose-insulin-potassium solution on ventricular late potentials and heart rate variability in acute myocardial infarction.

BACKGROUND: Blunted heart rate variability (HRV) and presence of ventricular late potentials (VLPs) are known to correlate with an increased risk of ventricular tachycardia and sudden cardiac death in acute myocardial infarction (AMI). In the present study, we investigated the effect of glucose-insulin-potassium (GIK) solution on the VLPs and HRV in AMI. METHODS: Seventy-two consecutive patients with first Q wave AMI were randomized to GIK solution and placebo. HRV analysis and ambulatory electrocardiographic recordings were taken in all patients between 24 and 48 h. Sub-maximal exercise testing and echocardiography were performed and signal-averaged electrocardiography (SAECG) was recorded before discharge. RESULTS: Total filtered QRS duration (FQRS: 102 +/- 7 versus 108 +/- 11 ms; P < 0.05), low-amplitude signal (LAS: 25 +/- 8 versus 32 +/- 11 ms; P < 0.01) and frequency of VLPs (21 versus 45%; P < 0.05) were found to be significantly lower while root-mean-square voltage of the terminal 40 ms of QRS (RMS-40: 45 +/- 18 versus 36 +/- 20 microV; P < 0.05), and left ventricular ejection fraction (EF: 55 +/- 6 versus 48 +/- 7; P < 0.05) were significantly higher in the GIK group when compared to placebo. During the hospital period, the presence and frequency of post-myocardial infarction angina were significantly lower in the GIK group (15 versus 29%, P < 0.05), whereas an insignificant decrease in frequency of ventricular arrhythmias was observed in these patients. On HRV analysis, there was no significant difference between two groups in either time domain (SD, SDNN, RMS-SD) or frequency domain (HF, LF, LF/HF ratio) parameters. CONCLUSION: GIK solution may be beneficial to VLPs, ischaemic events, and left ventricular systolic performance in the early period of AMI. This therapy has no significant effect on HRV in AMI patients.

The value of hemodynamic changes induced by carotid sinus massage on the diagnosis of coronary artery disease.

The aim of this study is to investigate the value of hemodynamic changes induced by carotid sinus massage (CSM) on the diagnosis of coronary artery disease (CAD). A total 108 patients (mean age, 54 +/- 10 years, range 33-70) who had no significant stenosis in the carotid artery by duplex ultrasonography (USG) and no history of syncope were included in this study. Carotid sinus massage was performed before coronary angiography with monitoring of electrocardiography and blood pressure. The patients were divided into three groups according to response to CSM: group 1 patients had a decrease in blood pressure or < 10 beats/minute (bpm); group 2 patients had a decrease between 10 and 20 bpm; and group 3 patients had > 20 mm Hg decrease in blood pressure or > 20 bpm. Coronary angiography was performed after CSM in all patients. There was single-vessel disease (VD) in 23 cases, two-VD in 24 cases, and three-VD in 35 cases. Coronary angiography results were normal in 26 cases. The changes in systolic and diastolic blood pressures and heart rate before and after CSM correlated with number of VD. These changes were highest in patients with three-VD, but lowest in patients with normal coronary angiography. The number of diseased vessels and total coronary artery score were lowest in group 1, but highest in group 3. The specificity and sensitivity of CSM-induced > 10 mm Hg in blood pressure (BP) or > 10 bpm changes in heart rate in the diagnosis of CAD were 85% and 71%, respectively. The positive and negative predictive values were 93% and 49%, respectively in the diagnosis of CAD. At the end of this study, we concluded that CSM induced the fall in blood pressure and heart rate and was correlated with number of diseased vessels and the score of coronary artery disease. As dichotomized values, the decrease of > 10 mm Hg in blood pressure and/or > 10 bpm has highest specificity, sensitivity, and positive predictive value in the diagnosis of CAD.

The effects of right ventricular involvement on heart rate variability and ventricular late potentials in acute inferior myocardial infarction.

Depressed heart rate variability and presence of ventricular late potentials in acute myocardial infarction are associated with a poor prognosis. Although it is known that the abnormalities vary according to anterior or inferior location of acute myocardial infarction, the relationship with right ventricular acute myocardial infarction is not clear. The effects of right ventricular myocardial infarction on heart rate variability and ventricular late potentials are studied. The study was performed with a total of 46 patients (38 males; aged 56 +/-13 yr, range, 33 to 70 yr). Twenty-six patients had isolated inferior myocardial infarction while 20 patients had accompanying right ventricular involvement. For all patients, ambulatory Holter recordings between 24 and 48 hours following myocardial infarction, echocardiography in first 48 hours, and signal-averaged electrocardiography with submaximal exercise at average day 6 (range, 5 to 8 days) were performed. Heart rate variability and signal-averaged electrocardiography recordings were repeated after discharge (average, 39 days). During the first 24 to 48 hr, time domain parameters (SDNN1 and SD1) were significantly lower (SDNN1: 62 +/- 17 vs 100 +/- 20 ms, p = 0.001; SD: 37 +/- 10 vs 50 +/- 16 ms, p = 0.03) in patients with isolated inferior MI than in those with right ventricular involvement, whereas root-mean-square voltage (RMS-SD1) showed no significant difference in both groups (28 +/- 7 vs 35 +/- 8 ms). In post-discharge heart rate variability recordings, there were no significant differences (SDNN2: 86 +/- 13 vs 95 +/- 15 ms; SD2: 48 +/- 11 vs 57 +/- 13 ms; RMS-SD2: 32 +/- 14 vs 35 +/- 9 ms). In pre-discharge tests, the mean value of low-amplitude signals (LAS1) was higher (26 +/- 9 vs 33 +/- 11 ms, p = 0.03) in patients with isolated inferior myocardial infarction than in those with right ventricular involvement, while other signal-averaged electrocardiography parameters were not significantly different (filtered QRS: 102 +/- 5 vs 105 +/- 10 ms, RMS-40(1): 44 +/- 13 vs 26 +/- 10 microV; incidence of ventricular late potentials: 23% vs 30%, p = NS, respectively). In post-discharge tests, all of signal-averaged electrocardiography parameters were similar in both groups (filtered QRS2: 112 +/- 12 vs 114 +/- 8 ms, LAS2: 28 +/- 9 vs 32 +/- 13 ms, RMS-40(2): 36 +/- 10 vs 34 +/- 11 microV, and frequency of ventricular late potentials2: 23% vs 30%, p = NS). These data suggest that right ventricular involvement in an acute inferior myocardial infarction is associated with improved heart rate variability parameters but not ventricular late potentials in pre-discharge period. However, the influence of right ventricular involvement on heart rate variability parameters fades away in the post-discharge period.

The effects of trimetazidine on heart rate variability and signal-averaged electrocardiography in early period of acute myocardial infarction.

BACKGROUND: Acute myocardial infarction (AMI) is accompanied by electrophysiological changes in cardiovascular system as well as those in autonomic cardiac control. Heart rate variability (HRV) is depressed due to increased sympathetic activity and/or decreased parasympathetic activity following AMI. Moreover, the frequency of ventricular late potentials (VLP) is increased due to the electrophysiological changes. Based on the hypothesis that the treatments increasing HRV and decreasing the frequency of VLP can improve the prognosis of AMI, we investigated the short-term effects of trimetazidine (TMZ) on HRV and VLP in patients with AMI. METHODS: The study group consisted of 64 patients (men 49, mean age 55+/-12 years, range 26-70) suffering from first Q-wave AMI. Thirty-one of them were treated with conventional therapy (thrombolytic therapy, aspirin, beta-blocker, heparin and intravenous nitroglycerin) plus TMZ 20 mg tid. The remaining 33 patients served as controls. Holter monitorization between 24 and 48 h, echocardiography at average day 6 (range 4-7 days) and SAECG and sub-maximal exercise at average day 7 (range 6-9 days) were performed to all patients. RESULTS: While HRV parameters reflecting parasympathetic activity (SDSD: 43+/-16 ms-35+/-13 ms, RMSSD: 34+/-14 ms-27+/-8 ms, HF: 7.8+/-5 ms(2) -4.3+/-4 ms(2), P<0.05) were of significantly higher levels in TMZ group, the low frequency component mainly reflecting sympathetic activity (LF: 10+/-6 ms(2)-10+/-5 ms(2), P>0.05) was similar in both groups. In addition, LF/HF ratio showing sympatho-vagal balance was significantly decreased in TMZ group (1.5-3.0, P=0.005). About VLP, the mean FQRS (105+/-8 ms-107+/-10 ms), LAS (28+/-10 ms-30+/-11 ms) and RMS-40 (34+/-15 microV-41+/-12 microV) were not different in both two groups (P>0.05). CONCLUSION: Our results suggest that TMZ treatment causes changes in sympatho-vagal balance in favor of vagal activity by increasing parasympathetic activity in AMI at early period; however, no effect on VLP was observed.

[The relation of coronary artery disease with Doppler flow velocity and resistance index in cases without significant carotid artery stenosis]. / Anlamli karotid arter darligi olmayan olgularda Doppler akim hizlari ve rezistans indekslerinin koroner arter hastaligi ile iliskisi.

OBJECTIVE: Atherosclerosis causes functional vasomotor changes as well as well as atheromatous carotid plaques and luminal stenosis resulting in mechanical effect. The relation between functional vasomotor changes in carotid arteries and extent of coronary artery disease is unknown. In our study, the probable relationship between carotid arterial flow velocities and resistance indexes (RI) with the extent of coronary artery disease (CAD) in patients who do not have significant carotid luminal stenosis was evaluated. METHODS: One hundred and fourteen patients (74 males, mean age 53+/-10 years, range 33-72 years) were studied. All patients underwent color Doppler sonography before coronary angiography. Peak systolic flow velocity, end-diastolic flow velocity and resistance index (RI) of right and left common carotid and internal carotid and internal carotid arteries were measured by color Doppler sonographic technique. Doppler parameters were correlated with the extent of CAD and left ventricular ejection fraction. RESULTS: Patients were classified on the basis of presence of significant CAD and the number of affected coronary arteries. Thirty-three patients did not have (normal group) and 81 patients had significant coronary arterial stenosis (22 patients with one-vessel disease, 27, with two-vessel disease and 32 patients with three-vessel disease). Flow velocities were the highest in normal group but the lowest in CAD patients, especially when 3 coronary arteries were affected. Correlation analysis demonstrated negative relationship of age, ejection fraction and number of affected coronary arteries with end-diastolic flow velocity, but positive and significant correlation with RI value. CONCLUSION: Our study is the first on this object. The results suggest that presence and extent of CAD changes flow velocities and RI values of common and internal carotid arteries. However, further investigations are required before these parameters can be applied as diagnostic criteria.

A complicated case of pericardial hydatid cyst manifesting as constrictive pericarditis.

Although cardiac involvement with hydatid cyst is quite rare as a major complication, constrictive pericarditis is even less common. A 55-year-old man is presented in whom a hydatid cyst located in the right cardiophrenic angle anterior to the right ventricle ruptured into the pericardial sac, resulting in constrictive pericarditis.

Contribution of the peak exercise QT dispersion to the accuracy of an exercise test during the evaluation of coronary artery disease.

OBJECTIVE: Regional defects in ventricle repolarization are extremely sensitive to ischaemia which can be measured as QT dispersion (QTd). We investigated the role of QTd calculated at the time of peak exercise during treadmill studies. METHODS AND RESULTS: Thirty-three women and eighty men, whose treadmill test results and coronary angiography studies had been examined, were divided into four groups according to the test results: 1) subjects with a negative treadmill test and without significant stenosis results in the angiography, were considered normal (N; n = 35); 2) subjects with both a positive exercise test and a significant presence of stenotic coronary arteries, were considered true positive (TP; n = 52); 3) subjects with a positive exercise test, but without significant stenosis results in the angiography, were considered false positive (FP; n = 14); 4) subjects with a negative treadmill study, despite significantly stenotic arteries, were considered false negative (FN; n = 12). All subjects were evaluated on the basis of age, significant ST-segment depression, peak heart rate, rest and peak exercise QT, and QpT (measured from the beginning of the QRS complex to the highest point of the T wave) dispersion, and corrected (QTcd, QpTcd) values for heart rate. The most significant differences were observed between the N and the TP groups in terms of QTd and QTcd (p < 0.01), with a higher correlation (r = 0.48). A significant relationship was also observed in terms of QpT and QpTcd values during peak exercise (p < 0.01). The sensitivity of the peak exercise QTcd and QTcd > or = 70 ms in determining coronary artery disease was found to be 74%. In cases of QTcd > or = 70 ms, in addition to ST-segment depression, the test was found to be less sensitive, but more specific at 96%. CONCLUSION: It suggests that when peak exercise QTd and QpTd values are taken into account, with the exception of the ST-segment depression, the accuracy of the exercise test will increase and false positive results will decrease.

Cardiac hydatid cysts located in both the left ventricular apex and the intraventricular septum: case report.

Cardiac hydatid cyst is rarely encountered and constitutes 0.5%-2% of all hydatid cases. Although left ventricular (LV) location for hydatid cysts has been frequently reported, the involvement of both the left ventricle and the interventricular septum (IVS) has not been previously reported in the literature. We present a case of cardiac hydatid cyst with fatal recurrent cerebral embolism and the unusual involvement of both LV and IVS demonstrated by transthoracic echocardiography.

Relation between QT dispersion and ventricular arrhythmias in uncomplicated isolated mitral valve prolapse.

Complications of mitral valve prolapse (MVP), among which serious ventricular arrhythmia and sudden death are of major importance, affect many individuals due to the high incidence of MVP itself in the community despite the actual low incidence of these complications. The present study investigated the incidence and distribution of ventricular arrhythmias according to their severity and relationship with the QT interval and dispersion of repolarization in uncomplicated isolated MVP (IMVP) cases. Fifty-eight uncomplicated IMVP patients, 33 patients with accompanying tricuspid valve prolapse (TVP), to compare its relationship with ventricular arrhythmia, and 60 age- and sex-matched control subjects were enrolled in the study. Individuals with accompanying cardiac or systemic disease, or who were on drug therapy that could potentially affect QT characteristics, were excluded. The incidence of ventricular arrhythmia was 48% in the IMVP group and 64% in the TVP group; the difference was statistically insignificant. In addition, the differences of the QT and Q peak T values were insignificant, whereas QT dispersion (QTd) and Q peak T dispersion (QpeakTd) values were significantly higher in the patient group (60+/-14, 54+/-14 ms, respectively) compared with the control group (42+/-10, 38+/-10 ms, respectively, p<0.001). Complex ventricular arrhythmias (Lown Grade > or =III) in the IMVP group had a significant relationship with QTd and QpeakTd (p<0.001), but not with QT or QpeakT. As a result of the study, it is concluded that TVP accompanying MVP does not increase the incidence of ventricular arrhythmia, that ventricular arrhythmia is related to QT dispersion rather than QT interval in IMVP, that the QT dispersion is a fairly good marker for identifying the high-risk group for serious ventricular arrhythmia and sudden death, and that QpeakT dispersion measurement is an additional indicator that could be an alternative when QT is difficult to determine in conditions such as high heart rate or the presence of U wave.