The Effect of Anthropometric Measurements on the Incidence of Atrial Fibrillation in Patients With Acute Myocardial Infarction.

Background and objective Atrial fibrillation (AFib) is the most common supraventricular arrhythmia occurring after myocardial infarction (MI). Height, body weight, waist and hip circumference, and body mass index (BMI) are considered potential risk factors for the development of AFib. The aim of this study was to investigate the effect of BMI and waist circumference on the incidence of AFib in patients with acute MI. Methods This prospective, cross-sectional, observational study was conducted in the coronary intensive care unit (CICU) of a tertiary care university hospital between July 2014 and February 2016. Patients diagnosed with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) were included. Demographic, clinical, echocardiographic, and laboratory data, past medical history, and anthropometric measurements were recorded. Continuous electrocardiography (ECG) monitoring was performed for following up on the occurrence of AFib. Then, AFib predictors were identified using multiple regression analysis. Results AFib developed in 31 (9.3%) patients in the cohort. No significant difference was observed between patients with or without AFib in terms of BMI and waist circumference values (p=0.686 vs. p=0.728, respectively). Factors associated with AFib development as per the multivariate analyses included age (OR: 1.051, 95% CI: 1.013-1.09; p=0.008), pulse rate (OR: 1.043, 95% CI: 1.018-1.069; p=0.001), peak troponin T value (OR: 1.356, 95% CI: 1.135-1.619; p=0.001), and length of CICU stay (OR: 2.247, 95% CI: 1.163-4.340; p=0.016). Conclusion BMI and waist circumference measurements were similar in patients with and without AFib during acute MI. Age, pulse rate, peak troponin T, and duration of CICU stay were identified as independent predictors of AFib development.

Aortic propagation velocity does not correlate with classical aortic stiffness parameters in healthy individuals.

OBJECTIVE: Aortic stiffness is an important cardiovascular risk marker, which can be determined using different noninvasive techniques. Aortic propagation velocity (APV) has recently been established as a novel echocardiographic parameter of aortic stiffness. This study aimed to investigate the association between APV and the classical echocardiography-derived aortic stiffness parameters, aortic distensibility (AD) and aortic strain (AS), in a group of otherwise healthy individuals. METHODS: In total, 97 consecutive healthy subjects were recruited in this observational study. APV was measured using color M-mode echocardiography from the suprasternal window in the descending aorta. AS and AD were calculated using clinical blood pressure and the M-mode echocardiography-derived aortic diameters. Correlation analyses were performed between cardiovascular risk factors related to increased aortic stiffness (age, obesity, and blood pressure) and measured stiffness parameters (APV, AS, and AD). Correlation analyses were also performed among the measured stiffness parameters. RESULTS: Good correlation of age, blood pressure, and BMI with AS and AD was observed. One-on-one correlation of age, blood pressure, and BMI with APV was not observed. No correlation was observed between APV and AS (r=-0.05, p=0.6) or between APV and AD (r=-0.17, p=0.8). CONCLUSION: Although APV has been proposed as a novel and practical echocardiographic parameter of aortic stiffness, especially in patients with coronary artery disease, correlations between classical stiffness parameters (AS and AD) and APV were absent in healthy individuals at low-intermediate risk. The clinical and research applicability of APV should be further evaluated.

The association of plasma oxidative status and inflammation with the development of atrial fibrillation in patients presenting with ST elevation myocardial infarction.

Atrial fibrillation (AF) is the most common supraventricular arrhythmia following ST elevation myocardial infarction (STEMI). Oxidative stress and inflammation may cause structural and electrical remodeling in the atria making these critical processes in the pathology of AF. In this study, we aimed to evaluate the association between total oxidative status (TOS), total antioxidative capacity (TAC) and high-sensitivity C-reactive protein (hs-CRP) in the development of AF in patients presenting with STEMI. This prospective cohort study consisted of 346 patients with STEMI. Serum TAC and TOS were assessed by Erel's method. Patients were divided into two groups: those with and those without AF. Predictors of AF were determined by multivariate regression analysis. In the present study, 9.5% of patients developed AF. In the patients with AF, plasma TOS and oxidative stress index (OSI) values were significantly higher and plasma TAC levels were significantly lower compared to those without AF (p = .003, p = .002, p < .0001, respectively). Multivariate regression analysis results showed that, female gender (Odds ratio [OR] = 3.07; 95% Confidence Interval [CI] = 1.26-7.47; p = .01), left atrial diameter (OR =1.28; 95% CI =1.12-1.47; p < .0001), hs-CRP (OR =1.02; 95% CI =1.00-1.03; p = .001) and OSI (OR =1.10; 95% CI =1.04-1.18; p = .001) were associated with the development of AF in patients presenting with STEMI. The main finding of this study is that oxidative stress and inflammation parameters were associated with the development of AF in patients presenting with STEMI. Other independent predictors of AF were female gender, left atrial diameter and hs-CRP.

Circadian Rhythm of Infarct Size and Left Ventricular Function Evaluated with Tissue Doppler Echocardiography in ST Elevation Myocardial Infarction.

BACKGROUND: We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI). METHODS: We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated. RESULTS: A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p=0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06:00-noon compared with period of noon-18:00 and 18:00-midnight (p=0.029 and p=0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9±7.3% versus 47.3±7.9%, p=0.018, and 7.6±1.4cm/s versus 8.2±1.6cm/s, p=0.003, respectively). CONCLUSIONS: This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06:00-noon period.

The first case of levetiracetam-induced and tolvaptan-resistant hyponatremia.

Hyponatremia is frequently seen in heart failure patients and has a high mortality rate. If not treated adequately, acute and chronic hyponatremia may worsen the prognosis of heart failure. Despite its high incidence in heart failure patients, other underlying conditions that possibly lead to the incidence of hyponatremia may be underestimated, thus making its treatment more difficult. In this case study, we describe a rare case of levetiracem-induced and tolvaptan-resistant hyponatremia.

A Case Series of Obstructive Prosthetic Mitral Valve Thrombosis, Successfully Treated with Low-Dose, Slow Infusion Tissue-Type Plasminogen Activator.

BACKGROUND AND AIM OF THE STUDY: Prosthetic valve thrombosis (PVT) is a rare but serious complication of the prosthetic heart valve. Although recent guidelines generally recommend surgical treatment as the main option for patients with obstructive left-sided PVT, thrombolytic therapy (TT) may offer another attractive approach. There is also no consensus on the type, dose and route of administration of thrombolytic agents. The present study included a small series of patients with low-dose, slow infusion tissue-type plasminogen activator (tPA) to treat PVT in the mitral position. METHODS: Eight consecutive episodes of mitral PVT (one woman was pregnant) in seven patients were treated with low-dose (25 mg), slow infusion (within 6 h) tPA, if needed, with repeat sessions of TT (with the same protocol up to a total dose of 150 mg) until a satisfactory result was achieved. RESULTS: The cause of PVT was inadequate anticoagulation with warfarin or low-molecular-weight heparin in all patients on admission. A complete resolution of hemodynamic instability and echocardiographic abnormalities was observed in all cases, without mortality. In addition, there were no thromboembolic and major hemorrhagic complications in the case series. CONCLUSION: These findings suggest that low-dose, slow infusion tPA may be applicable to bileaflet mitral PVT in relatively stable patients, and may represent a therapeutic option to surgery.

Late perforation of anterior mitral leaflet after surgical resection of the subaortic membrane.

A 54-year-old woman who underwent surgical resection of the subaortic membrane 10 years earlier presented with new onset dyspnea. Cardiovascular examination revealed 3-4/6 pansystolic murmur at the apex. She was found to have severe mitral regurgitation (MR) with transthoracic echocardiography; 2D and real-time-3D transesophageal echocardiography demonstrated severe MR through anterior mitral leaflet perforation with precise localization. The patient was treated with surgery in which the perforated segment was closed by direct suture technique and discharged on postoperative 5th day. .

Acute stent thrombosis and/or atrial fibrillation occurring after bee sting.

Acute stent thrombosis may result from many causes. Bee sting is a very rare cause of this situation. As bee venom activates some inflammatory and vascular events resulting in occlusion in vessels or diseases in electrical system of heart, it may cause myocardial infarction or atrial fibrillation. This problem may be temporary or fatal. Because of its pathologic effects, to be able to catch on and treat them shortly is very important.

Relationship between neutrophil-lymphocyte ratio and isolated low high-density lipoprotein cholesterol.

Several studies showed that high-density lipoprotein cholesterol (HDL-C) has anti-inflammatory effect. The neutrophil-lymphocyte ratio (NLR) is a new biomarker of systemic inflammation. The aim of this study was to assess the NLR in healthy participants with low HDL-C. We studied 69 patients with low HDL-C (≤ 35 mg/dL) and 59 control participants (HDL-C >35 mg/dL) with similar cardiovascular risk factors. Hematological indices were measured in all patients with low HDL-C and control participants. The HDL-C was significantly lower among the patients with low HDL-C than that of the control group (31.7 ± 2.7 vs 50.7 ± 5.0 mg/dL, respectively; P < .001). The NLR was significantly higher among the patients with low HDL-C than that of the control group (2.6 ± 0.8 vs 1.6 ± 0.4, respectively; P < .001). The NLR was negatively correlated with HDL-C (P < .001, r = -.53). The NLR is significantly elevated in patients with low HDL-C when compared with control participants.

Mean platelet volume is elevated in patients with low high-density lipoprotein cholesterol.

A low high-density lipoprotein cholesterol (HDL-C) level is a predictor of increased cardiovascular risk. We assessed the mean platelet volume (MPV) in patients with low HDL-C. We studied 59 patients with low HDL-C (HDL-C ≤35 mg/dL) and 56 control participants (HDL-C levels >35 mg/dL) with similar cardiovascular risk factors. As expected, HDL-C was significantly lower among the patients with low HDL-C than that of the control group (32 ± 3 vs 51 ± 5 mg/dL, respectively; P < .001). Platelet count was significantly lower among the patients with low HDL-C than that of the control group (213 ± 60 vs 285 ± 75 × 10(9)/L, respectively; P < .001). The MPV was significantly higher among the patients with low HDL-C than that of the control group (8.7 ± 0.6 vs 7.1 ± 0.5 fL, respectively; P < .001). We have shown that MPV was significantly elevated in patients with low HDL-C compared with control participants.

The relationship between coronary sinus and impaired right ventricular myocardial performance index in mitral stenosis.

OBJECTIVES: We aimed to investigate whether coronary sinus (CS) dilatation develops in patients with mitral stenosis (MS) and to demonstrate its relationship with the global myocardial performance of the right ventricle (RV). METHODS: We enrolled 34 patients with MS who underwent echocardiography after exhibiting typical symptoms (31 female; mean age 41 ± 12 years) and 20 age- and sex-matched controls without MS who underwent echocardiography (16 female; mean age 38 ± 13 years). The RV myocardial performance index (MPI) was detected using tissue Doppler echocardiography (TDE), and maximum CS diameter was measured from the posterior atrioventricular groove in the apical four-chamber view during the ventricular systole. RESULTS: The RV MPI was significantly higher in the MS group compared to the control group (0.60 ± 0.11 vs. 0.41 ± 0.08, P < 0.001). Moreover, the maximum CS dimension was higher in the MS group compared to the control group (8.5 ± 1.1 mm vs. 6.5 ± 1.4 mm, P < 0.001). The maximum CS dilatation was positively correlated with the RV MPI (r = 0.691; P < 0.001). CONCLUSION: The RV MPI, which represents both systolic and diastolic functions, is increased in patients with MS and correlates with CS dilatation.

The effect of smoking on myocardial performance index in middle-aged males after first acute myocardial infarction.

BACKGROUND: Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. MATERIAL AND METHODS: A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 48-72 hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. RESULTS: Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 ± 0.15 vs. 0.66 ± 0.14, P = 0.01), and Em/Am values were also higher in smokers (0.84 ± 0.28 vs. 0.75 ± 0.31, P = 0.01). Independent predictors of impaired MPI (≥0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.98-5.83, P = 0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.73-5.91 P = 0.001), and, age (odds ratio 1.12, 95% CI 1.03-1.22, P = 0.01). CONCLUSIONS: Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.

The evaluation of doxorubicin-induced cardiotoxicity: comparison of Doppler and tissue Doppler-derived myocardial performance index.

BACKGROUND: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. METHODS: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. RESULTS: All patients underwent control echocardiographic examination after mean 5 ± 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 ± 0.11, 0.61 ± 0.10, p = 0,005 vs 0.51 ± 0.09, 0.59 ± 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 ± 0.14, 0.50 ± 0.12, p = 0.56). CONCLUSIONS: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function.

Electrocardiographic findings in patients with polycythemia vera.

BACKGROUND: The 12-lead surface electrocardiogram (ECG) is a useful tool to predict both atrial and ventricular arrhythmias via P-wave and QT measurements and its derivatives. Polycythemia vera (PV) is a chronic myeloproliferative disorder associated with cardiovascular events. The aim of this study was to assess ECG findings of patients with PV. METHOD AND MATERIALS: Sixty patients with PV (34 male, mean age 58±11 years) and 60 age and gender-matched healthy volunteers were enrolled into the study. From the 12-lead surface ECG, P-wave and both conventional QT measurements and transmyocardial repolarization parameters (T(peak)-T(end) interval (T(p)-T(e)) and derivatives) were evaluated digitally by two experienced cardiologists. In addition, a novel parameter, Pi was calculated digitally as the standard deviation of the P-wave duration across the 12 ECG leads. RESULTS: QT duration and corrected QT interval were significantly longer in the PV group compared to healthy controls (p<0.01 and p<0.01, respectively). The T(p)-T(e) was longer and the T(p)-T(e)/QT ratio was significantly higher in the PV group compared to the controls. P-wave analyses showed that all P-wave parameters including Pmax, Pmin, P dispersion, and Pi were significantly prolonged in PV patients compared to the controls. The increase of both T(p)-T(e )and P max in the PV group was independent of age, BMI, diabetes and hypertension, gender, systolic blood pressure, hemoglobin, hematocrit, left atrial dimension, left ventricular end-diastolic diameter and early deceleration time in a univariate analysis of co-variance model (F=11.097, p=0.001 and F=31.537, p=0.0001, respectively). CONCLUSION: The present study demonstrated that PV may be associated with electrocardiographic abnormalities of both atrium and ventricle.

The relation between Lp-PLA2 levels with periodic limb movements.

OBJECTIVE: Lipoprotein-associated phospholipase A2 (Lp-PLA2), a novel marker of vulnerable plaque to prone rupture, is a predictor of both cardiovascular event and cerebrovascular event, and highly sensitive-C-reactive protein (hs-CRP) is an acute-phase response protein implicated in a broad range of cardiovascular diseases. We aimed to examine the association between periodic limb movements in sleep (PLMs) with circulating Lp-PLA2 and hs-CRP levels in patients with PLMs. METHODS: Seventy patients with newly diagnosed PLM with polysomnography were enrolled this study. Patients were divided into two groups according to PLM index (normal PLM index, <15; elevated PLM index, ≥15). Lp-PLA2 and hs-CRP concentrations were measured in serum samples by turbidimetric and nephelometric methods, respectively. The concentrations of these parameters were compared between two groups and correlation analysis was performed between PLMs and Lp-PLA2 and hs-CRP levels. RESULTS: Lp-PLA2 levels and hs-CRP were significantly increased in elevated PLM index group compared with the control group (206.8 ± 78.1 vs 157.8 ± 56.7, p = 0.003, and 4.2 ± 3.5 vs 2.4 ± 2.1, p = 0.02, respectively). PLM index was positively correlated with Lp-PLA2 levels (r = 0.40, p = 0.001) and hs-CRP (r = 0.24, p = 0.05). In the linear regression model, Lp-PLA2 was an independent predictor of PLM index (R(2) = 0.36, p = 0.005). CONCLUSION: This study demonstrated an independent linear relation between PLM index and Lp-PLA2. In addition, it was seen increased Lp-PLA2 and hs-CRP levels in patients with elevated PLM index. Based on these results, we can suggest that risk of vascular events may be increased in patients with PLMs and with increased PLM index.