Transcoronary Gradients of Mechanosensitive MicroRNAs as Predictors of Collateral Development in Chronic Total Occlusion.

Background and Objectives: In this present study, we investigated the impact of mechanosensitive microRNAs (mechano-miRs) on the collateral development in 126 chronic total occlusion (CTO) patients, selected from 810 undergoing angiography. Materials and Methods: We quantified the collateral blood supply using the collateral flow index (CFI) and assessed the transcoronary mechano-miR gradients. Results: The patients with favorable collaterals had higher CFI values (0.45 ± 0.02) than those with poor collaterals (0.38 ± 0.03, p < 0.001). Significant differences in transcoronary gradients were found for miR-10a, miR-19a, miR-21, miR-23b, miR-26a, miR-92a, miR-126, miR-130a, miR-663, and let7d (p < 0.05). miR-26a and miR-21 showed strong positive correlations with the CFI (r = 0.715 and r = 0.663, respectively), while let7d and miR-663 were negatively correlated (r = -0.684 and r = -0.604, respectively). The correlations between cytokine gradients and mechano-miR gradients were also significant, including Transforming Growth Factor Beta with miR-126 (r = 0.673, p < 0.001) and Vascular Endothelial Growth Factor with miR-10a (r = 0.602, p = 0.002). A regression analysis highlighted the hemoglobin level, smoking, beta-blocker use, miR-26a, and miR-663 as significant CFI determinants, indicating their roles in modulating the collateral vessel development. Conclusions: These findings suggest mechanosensitive microRNAs as predictive biomarkers for collateral circulation, offering new therapeutic perspectives for CTO patients.

Increased Cardio-ankle Vascular Index Values in Migraine Patients With Aura.

Patients with migraine with aura are at an increased risk of cardiovascular disease. There are limited data on arterial stiffness in migraine patients with aura. The present study evaluated arterial stiffness in these patients using the cardio-ankle vascular index (CAVI). This prospective study included 50 patients with migraine with aura (43 female, mean age 38.9 ± 9.9 years). The patient group was matched for age and gender with 50 healthy individuals with no history of migraine (43 female, mean age 39.3 ± 10.3 years). All patients and control subjects underwent a comprehensive clinical evaluation by an experienced neurologist and were interviewed about their headache histories. There was no significant difference in baseline demographic characteristics and echocardiographic parameters between migraine with aura patients and the control group. Both right and left CAVI values were significantly higher in the patients with migraine with aura (6.5 ± 1.2 vs 6.1 ± 0.7, P = .043 and 6.6 ± 1.2 vs 6.1 ± 0.7, P = .009, respectively). Arterial stiffness is an important mediator of cardiovascular diseases. We found that CAVI, a novel marker of the arterial stiffness, is increased in patients with migraine with aura.

Cardio-ankle vascular index represents the best surrogate for 10-year ASCVD risk estimation in patients with primary hypertension.

Background: Identification of target organ damage and/or risk-enhancing factors help treatment decisions in hypertensive and hyperlipidaemic patients who reside in borderline to an intermediate risk category based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimates.Aim: In the present study, we aimed to investigate the comparative efficacy of certain hypertension-mediated organ damage markers (HMOD) for the prediction of 10-year ASCVD risk ≥10%, in patients with primary hypertension without established CVD.Methods: One-hundred thirty-seven asymptomatic hypertensive patients ≥40 years of age were enrolled in the present study. Ten-year ASCVD risks were estimated by Pooled Cohort Equations. The following HMOD markers; pulse pressure (PP), left ventricular mass index (LVMI), carotid intima-media thickness (CIMT), ankle-brachial index (ABI), cardio-ankle vascular index (CAVI) and estimated glomerular filtration rate (eGFR) were evaluated with respect to efficacy for predicting ≥10% ASCVD risk with ROC analysis.Results: CAVI gave the greatest Area Under Curve (AUC = 0.736, p < .000), and followed by CIMT (AUC = 0.727, p < .000), LVMI (AUC = O.630, p = .01), and PP (AUC = 0.623, p = .02). ABI and eGFR were not found to be predictive. CAVI correlated best with estimated 10-year ASCVD risk (r = 0.460, p < .000). A CAVI value ≥8 was found 71% sensitive and 72% specific for predicting ≥10% risk in 10-year ASCVD risk scale. CAVI gave the best graded response to increments in 10-year ASCVD risk categories.Conclusion: We suggest that CAVI is the best surrogate for 10-year ASCVD risk, among several HMOD markers.

Apelin, Omentin-1, and Vaspin in patients with essential hypertension: association of adipokines with trace elements, inflammatory cytokines, and oxidative damage markers.

BACKGROUND: Hypertension (HT) is a disease associated with endothelial dysfunction which is related to some adipokines and pro- and anti-inflammatory cytokines. AIMS: Our aim was to investigate roles of apelin, omentin-1, and vaspin in essential HT and to evaluate their relationships with other pro- and anti-inflammatory cytokines, trace elements, and oxidative stress. We also investigated these parameters to determine asymptomatic target organ damage period and grading essential hypertension. METHODS: One hundred fifty-three patients diagnosed with essential hypertension and 45 healthy controls were included in the study. Hypertension was defined as a systolic blood pressure > 140 mmHg and/or a diastolic blood pressure > 90 mm Hg or current use of an antihypertensive medication. The patients who had secondary HT, other chronic metabolic, cardiovascular, cerebrovascular diseases were excluded. History and physical exam including detailed cardiovascular examination were performed in all participants. Adipokines, cytokines, trace elements, lipid peroxidation, and ischemia-modified albumin levels were measured in blood samples by biochemical methods. RESULTS: Vaspin, IL-4, IL-8, IL-10, selenium, and zinc levels were significantly lower in the HT group compared to healthy controls while omentin-1, TNF-α, copper, iron, MDA, SOD, and IMA-C levels were significantly higher in HT patients compared to controls. Multiple ordinal regression revealed that TNF-α, IL-10, and body mass index of patients were statistically significant independent predictors (P = 0.024, P = 0.019, and P = 0.032, respectively) for grading of HT. IL-4 and IL-10 were significantly higher in patients with asymptomatic target organ damage, compared to patients without asymptomatic target organ damage (P = 0.032 and P = 0.015, respectively). Our findings suggest that adipokines apelin, omentin, and vaspin may be involved in hypertension by a complex interaction with the anti- and pro-inflammatory cytokines, trace elements, and oxidative stress pathways.

Percutaneous angioplasty in the treatment of thrombosed hemodialysis fistulas: A single-center experience with 1 year of follow-up.

OBJECTIVE: Thrombosis of a hemodialysis arteriovenous fistula (AVF) is a serious complication that needs urgent treatment. Most cases are treated surgically, but recently, endovascular strategies have become a viable alternative. This study is an evaluation of the success and patency rate of percutaneous balloon angioplasty of thrombosed hemodialysis fistulas using a drug-coated balloon (DCB) contrasted with a standard balloon (SB). METHODS: The data of 33 patients with a thrombosed native hemodialysis AVF treated percutaneously in a tertiary care center were analyzed retrospectively. Success of the procedure was defined as restoration of flow with less than 30% residual stenosis and resumption of dialysis through the hemodialysis AVF. The success rate of the procedure and the patency rate at 1, 6, and 12 months were evaluated. The effect on patency of a DCB was compared to that of a SB. RESULTS: Twenty-five radiocephalic and 8 brachiocephalic thrombosed hemodialysis AVFs were treated during the study period. Flow was restored in 23 thrombosed fistulas, a success rate of 69.7%. The patency rate of successfully treated fistulas was 95.6% at 1 month, 76.1% at 6 months, and 57.9% at 12 months. Ten of the 23 re-established AVFs were treated with a DCB and the remainder were treated with a SB. The patency of the fistulas treated with a DCB was similar to that of a SB at 1 month (100% vs 92.3%, respectively; p=0.393). The patency rate of a DCB was greater than that of a SB at 6 months (88.9% vs 66.7%, respectively; p=0.258) and 12 months (75% vs 45.4%, respectively; p=0.219). CONCLUSION: Percutaneous intervention for thrombosed hemodialysis AVFs is a safe, minimally invasive, and effective procedure. There was a positive trend in the patency rate of patients treated with a DCB at 6 and 12 months compared with a SB.

Percutaneous Coronary Intervention for Chronic Total Occlusion versus Percutaneous Coronary Intervention for Non-Complex Coronary Lesions: Is There a Different Impact on Thyroid Function?

OBJECTIVE: This study assessed whether high levels of iodide administered during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) differentially influenced thyroid function compared to PCI for non-complex coronary lesions. SUBJECTS AND METHODS: A total of 615 patients were enrolled in the study; 205 underwent elective PCI for CTO lesions (Group I) and 410 underwent elective PCI for non-complex lesions including non-CTO, non-bifurcation, non-calcified, and non-tortuous lesions (Group II). Patients were monitored for development of incidental thyroid dysfunction between 1 and 6 months after PCI. RESULTS: The patients in Group I were administered a median of 255 mL of contrast medium during PCI for CTO; a median of 80 mL was administered to the patients in Group II during non-complex PCI (p =0.001). Ten (5.4%) of the 186 euthyroid patients in Group I and 19 (5%) of the 379 eu-thyroid patients in Group II developed subclinical hyper-thyroidism (p = 0.854). However, 7 (50%) of the 14 subclinical hyperthyroid patients in Group I and only 3 (12%) of the 25 subclinical hyperthyroid patients in Group II developed overt hyperthyroidism (p = 0.019). CONCLUSION: In euthyroid patients, PCI for coronary CTO lesions did not increase the risk for subclinical hyperthyroidism when compared to PCI for non-complex coronary lesions. However, in patients with subclinical hyperthyroidism at baseline, PCI for coronary CTO lesions significantly increased the development of overt hyperthyroidism when compared to PCI for non-complex coronary lesions.

Is trans-radial approach related to an increased risk of radiation exposure in patients who underwent diagnostic coronary angiography or percutaneous coronary intervention? (The SAKARYA study).

OBJECTIVE: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. METHODS: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). RESULTS: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. CONCLUSION: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.

Is endocan a biochemical marker for asymptomatic target organ damage in hypertensive patients?

OBJECTIVE: Identification of the asymptomatic target organ damage (AOD) helps to stratify the overall risk of cardiovascular (CV) diseases and guides a treatment decision in hypertensive patients without a symptomatic CV or renal disease. The endothelial-cell-specific molecule 1 (endocan) is regarded as a novel marker of endothelial dysfunction. Its release is increased in hypertensive patients, especially those with symptomatic CV and renal disease. In the present study, we aimed to evaluate the endocan levels in asymptomatic hypertensive patients with or without AOD. METHODS: The study included 132 asymptomatic hypertensive patients, and 101 of who had at least one AOD. RESULTS: Serum endocan levels did not differ between patients with and without AOD (3.81±0.78 vs. 3.83±0.63 ng/mL, p=0.88). An analysis according to the presence of any specific AOD did not show any difference between groups. No significant correlation was found between serum endocan levels and any of the continuous variables related to AOD, such as the pulse pressure, carotid intimae-media thickness, cardio-ankle vascular index, ankle-brachial index, left ventricular mass index, Sokolow-Lyon index, Cornell voltage-duration product, and estimated glomerular filtration rate. CONCLUSION: Endocan may not serve as a useful biomarker at asymptomatic vascular stages of hypertension, despite its role in indicating disease severity and inflammatory activation in advanced symptomatic CV and renal disease.

Impact of direct stenting on clinical outcomes for small vessel coronary artery disease in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.

INTRODUCTION: Direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking. AIM: To compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI. MATERIAL AND METHODS: A cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death. RESULTS: The primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group (p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups (p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group. CONCLUSIONS: In selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time.

Successful percutaneous treatment of coronary steal syndrome with the amplatzer vascular plug 4 and coil embolization.

The left internal mammary artery (LIMA) is widely used in coronary artery bypass grafting surgery due to its long term perfect patency rates. However, coronary steal syndrome can occur because of unligated LIMA side branches and it causes blood flow from coronary artery to LIMA. Even though the optimal therapy of coronary steal syndrome is still controversial, some percutaneous and surgical treatment modalities can be used in the treatment of steal phenomenon for relieving angina and resolving ischemia. It was demonstrated that percutaneous treatments such as the use of gelatin sponge particles or drug-eluting stents with covered stent, and coil and vascular plug embolization were used to treat this phenomenon successfully. Several studies revealed that these percutaneous treatments can reduce the ischemic area and results in prevention of blood flow from coronary artery to LIMA side branches. Supporting these findings, we herein present a 48-year-old male patient with objective ischemia with coronary steal syndrome treated successfully with the Amplatzer vascular plug (AVP) 4 and coil embolization in the same procedure. To the best of our knowledge, the combined therapy has not been described in the literature yet. Supporting the literature findings, successful treatment of LIMA side branches in our case with two different percutaneous modalities results in improvement of coronary flow and a reduced ischemic area and angina.

Cutaneous analgesia before transradial access for coronary intervention to prevent radial artery spasm.

AIM: Transradial access (TRA) for coronary intervention is increasingly used in current clinical practice. The aim of the present study was to evaluate the hypothesis that cutaneous analgesia before TRA for coronary intervention at a puncture site 30 minutes before puncture can reduce patient discomfort and the incidence of radial artery spasm (RAS). METHODS: Patients (n=104) undergoing planned coronary interventions using TRA were prospectively randomized to receive either 1 mL of 1% lidocaine subcutaneously (n=52) (control group) or subcutaneous lidocaine plus 5% lidocaine cream (n=52) cutaneously 30 minutes before puncture (treatment group). The primary endpoint was angiographically or clinically confirmed RAS. Secondary endpoints were the occurrence of patient discomfort in the forearm during the procedure and access-site crossover to the femoral artery. Patient discomfort was quantified with a visual analogue scale (VAS) score. RESULTS: Fifty-two patients in the treatment group (60.5±9.4 years of age and 16 female) and 52 patients in the control group (60.4±9.7 years of age and 16 female) were included in the final analysis. Radial artery spasm occurrence decreased in the treatment group compared to the control group (26.9% vs 9.6%; p=0.04) accompanied by a VAS score of 3.7±1.8 in the treatment group and 4.9±2.0 in the control group; p=0.02. The access site crossover rate did not differ between the groups (7.6% vs 21.1%; p=0.09). CONCLUSION: Cutaneous analgesia before TRA for coronary interventions is associated with a substantial reduction in the RAS and the procedure-related level of patient discomfort.

Comparison of closed-cell and hybrid-cell stent designs in carotid artery stenting: clinical and procedural outcomes.

INTRODUCTION: Carotid artery stenting (CAS) is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate. AIM: To compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices. MATERIAL AND METHODS: All CAS procedures with both closed- and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA) vasospasm rates were compared between the closed-cell and hybrid-cell stent groups. RESULTS: The study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular) (mean age: 68.5 ±8.6; 67.1% male) and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic) (mean age: 67.2 ±12.8; 68.2% male). There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23%) compared with the hybrid-cell stent group (10 patients, 11%) (p = 0.017). CONCLUSIONS: The results of this study showed no significant difference in the clinical adverse event rates after CAS between the closed-cell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.

Left ventricular twist was decreased in isolated left bundle branch block with preserved ejection fraction.

OBJECTIVE: Left ventricular (LV) rotation and twist play an important role in LV contraction and relaxation. Left bundle branch block (LBBB) deteriorates both diastolic and systolic functions. We evaluated the LV twist in patients with LBBB and preserved ejection fraction (EF) (>50%) to determine twist as a potential marker for subtle myocardial dysfunction. METHODS: This observational cross-sectional study included 34 LBBB patients with preserved EF who were free from ischemic and valvular disease (Group 1) and 36 healthy controls (Group 2). All patients underwent 2-D Doppler and 2-D speckle tracking echocardiography. LV apical, basal rotation, and twist were evaluated in both groups and compared accordingly. In addition, subjects were dichotomized considering the median twist value of the study population. Binary logistic regression analysis was performed to determine the independent variables associated with inframedian twist. RESULTS: Baseline clinical characteristics were similar in LBBB patients and controls. Mean apical rotation (2.5°±1.9° vs. 4.4°±2.9°; p=0.002), basal rotation (-2.9°±2.3° vs. -4.1°±2.7°; p=0.05), and twist (5.4°±3° vs. 8.6°±3.3°; p<0.001) were decreased in group 1. Parameters related to intra- and interventricular mechanical dyssynchrony, such as longitudinal left ventricular dyssynchrony index (LVdys) and preejection interval of LV, interventricular mechanical delay (IVMD), and left posterior wall contractions (SPMWD) were significantly higher in the LBBB group. The median twist value of the studied population was 6.65°. Binary logistic regression analysis showed that only presence of LBBB was independently associated with inframedian twist (OR=6.250; 95% CI: 2.215-17.632; p<0.001). CONCLUSION: The LBBB might have induced the reduction of LV twist by diminishing the LV rotation before inducing a prominent effect on the left ventricular ejection fraction (LVEF). Therefore, twist may be considered as a marker for subtle LV dysfunction in LBBB with substantially normal EF.

Usefulness of Heart-Type Fatty Acid-Binding Protein and Myocardial Performance Index for Early Detection of 5-Fluorouracil Cardiotoxicity.

In the present study, we aimed to evaluate temporal changes in heart-type fatty acid-binding protein (h-FABP) and myocardial performance index (Tei index) following administration of 5-fluorouracil (5-FU), a chemotherapeutic agent associated with myocardial ischemia induced by coronary vasospasm. Thirty-two patients with cancer receiving their first 5-FU-based chemotherapy were included in the study. Prior to chemotherapy and 24 hours after the initiation of chemotherapy, all patients underwent a comprehensive echocardiographic examination. Blood samples were taken for h-FABP and troponin I (TnI) measurements at different time points during the first 24 hours of 5-FU administration. Postinfusion echocardiography revealed worsening in Tei index (0.37 ± 0.08 vs 0.43 ± 0.07, P < .001). Clinically overt cardiotoxicity was evident in 4 (12.5%) of our patient population. Heart-type fatty acid binding protein and TnI levels were within normal ranges at all time points. Our results suggest that ischemia coronary vasospasm due to 5-FU cardiotoxicity should be reviewed. Furthermore, Tei index might be a sensitive indicator of occult 5-FU cardiotoxicity.

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience.

BACKGROUND: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. PATIENTS AND METHODS: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. RESULTS: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). CONCLUSIONS: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.