Safety and efficacy results of percutaneous renal stent implantation in patients with acute coronary syndrome with ectatic and aneurysmatic coronary arteries.

BACKGROUND: For the treatment of stenotic lesions developing in dilated coronary arteries, it is difficult to find an appropriately sized coronary stent given that the vessel diameter is too large. This poses a greater problem, especially in patients who require urgent intervention, such as acute coronary syndrome. OBJECTIVE: We aimed to evaluate the efficacy and safety of renal stents implanted in ectatic/aneurysmatic coronary arteries in such patients. METHODS: In total, 18 patients (renal stent group) who underwent renal stent implantation in ectatic/aneurysmatic coronary arteries requiring percutaneous coronary intervention (PCI) and 45 patients who underwent large-sized bare-metal coronary stent (BMCS) implantation (BMCS group) at our center were included in the study. The primary endpoints were MACE (myocardial infarction and cardiovascular mortality), and the secondary endpoints were restenosis and all-cause mortality. RESULTS: In the study patients with a mean follow-up of 25.3 ± 14.6 months (1-48 months), the control coronary angiography duration was 24.6 ± 14.8 months for the renal stent group and 22.8 ± 15.7 months for the BMCS group (p = 0.06). The MACE was observed in 2 (11.1%) patients in the renal stent group and 4 (8.9%) patients in the BMCS group (HR: 1.39 (0.24-7.82), p = 0.70). The secondary composite outcome was identified in 4 (22.2%) patients in the renal stent group and 6 (13.7%) patients in the BMCS group (HR: 1.93 (0.53-6.91), p = 0.31). No significant differences in primary and secondary outcomes were noted between the groups. CONCLUSION: Renal stents used during PCI in patients with acute coronary syndrome with ectatic/aneurysmatic coronary arteries have similar efficacy, and mid-term follow-up results those noted for BMCS. These findings support that renal stents can be used in ectatic and aneurysmatic coronary arteries when necessary. CLINICAL TRIAL REGISTRATION: This study has been registered on ClinicalTrials.gov (NCT05410678).

In vitro evaluation of anticoagulant therapy management when urgent percutaneous coronary intervention is required in rivaroxaban-treated patients.

We investigated in vitro the management of intraprocedural anticoagulation in patients requiring immediate percutaneous coronary intervention (PCI) while using regular direct oral anticoagulants (DOACs). Twenty-five patients taking 20 mg of rivaroxaban once daily comprised the study group, while five healthy volunteers included the control group. In the study group, a beginning (24 h after the last rivaroxaban dose) examination was performed. Then, the effects of basal and four different anticoagulant doses (50 IU/kg unfractionated heparin (UFH), 100 IU/kg UFH, 0.5 mg/kg enoxaparin, and 1 mg/kg enoxaparin) on coagulation parameters were investigated at the 4th and 12th h following rivaroxaban intake. The effects of four different anticoagulant doses were evaluated in the control group. The anticoagulant activity was assessed mainly by anti-factor Xa (anti-Xa) levels. Beginning anti-Xa levels were significantly higher in the study group than in the control group (0.69 ± 0.77 IU/mL vs. 0.20 ± 0.14 IU/mL; p < 0.05). The study group's 4th and 12th-h anti-Xa levels were significantly higher than the beginning level (1.96 ± 1.35 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.001 and 0.94 ± 1.21 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.05, respectively). Anti-Xa levels increased significantly in the study group with the addition of UFH and enoxaparin doses at the 4th and 12th h than the beginning (p < 0.001 at all doses). The safest anti-Xa level (from 0.94 ± 1.21 to 2.00 ± 1.02 IU/mL) was achieved 12 h after rivaroxaban with 0.5 mg/kg enoxaparin. Anticoagulant activity was sufficient for urgent PCI at the 4th h after rivaroxaban treatment, and additional anticoagulant administration may not be required at this time. Twelve hours after taking rivaroxaban, administering 0.5 mg/kg of enoxaparin may provide adequate and safe anticoagulant activity for immediate PCI. This experimental study result should confirm with clinical trials (NCT05541757).

The effect of contrast agents on the anticoagulant properties of oral factor Xa inhibitors.

BACKGROUND: Contrast agents may affect the anticoagulant properties of novel oral anticoagulants. PURPOSE: To evaluate the effect of iohexol as a contrast agent on the anticoagulant activity of oral factor Xa inhibitors. MATERIAL AND METHODS: The study included 65 individuals who underwent contrast computed tomography(CT). Group 1 comprised 20 patients using rivaroxaban, Group 2, 20 patients using apixaban, and Group 3, 20 patients using edoxaban. Group 4 was the control group of five healthy volunteers. Iohexol (60 mL) was used as a contrast agent. Blood samples of 2 mL were withdrawn into two tubes at 4 h after the drug dose and 1 h after the contrast CT (CT was performed 3 h after the drug was taken) from all the patients, and for the control group, at any time before and 1 h after contrast CT. The anticoagulant properties of rivaroxaban, apixaban, and edoxaban were evaluated using anti-factor Xa levels. RESULTS: The anti-factor Xa level was increased after using the contrast agent in the rivaroxaban group (0.66 ± 0.32 U/mL vs. 0.67 ± 0.32 U/mL; P = 0.01) and the edoxaban group (0.74 ± 0.35 U/mL vs. 0.76 ± 0.36 U/mL; P = 0.006). No significant difference was observed in the apixaban group (0.66 ± 0.33 U/mL vs. 0.66 ± 0.32 U/mL; P = 0.21) and control group (0.02 ± 0.01 U/mL vs. 0.03 ± 0.01 U/mL; P = 0.33). CONCLUSION: The anticoagulant properties of rivaroxaban and edoxaban tended to increase significantly, but there was no statistically significant difference in the anticoagulant properties of apixaban after the administration of contrast agent. To determine whether the small laboratory difference has a clinical effect, there is a need for larger clinical trials (NCT04611386).

The way to a patient's heart is through their esophagus: A case of esophago-pericardial fistula.

Here in we present a 74-year-old case of esophago-pericardial fistula with pericardial effusion and pneumopericardium. Bone-related esophageal trauma was the cause of the esophago-pericardial fistula. The esophago-pericardial fistula was diagnosed with echocardiography, computerized tomography (CT) and endoscopy. Pericardiocentesis was performed for drainage the pericardial effusion. The esophago-pericardial fistula was treated with covered self-expandable esophageal stent.

The Predictive Value of the Left Atrial Kinetic Energy for Atrial Fibrillation Recurrence.

Background and aim Determining which patients will experience recurrence of atrial fibrillation (AF) is crucial for treatment modification. This study aimed to investigate the predictive value of left atrial kinetic energy (LAKE) in AF recurrence. Materials and methods A total of 120 consecutive patients who achieved sinus rhythm (SR) with electrical direct current cardioversion and met the inclusion criteria were included in the study. Transthoracic echocardiography (TTE) and LAKE values were calculated on the first day after cardioversion. Rhythm control was performed with 12-lead electrocardiography in the first-month follow-up. Results While 81 (67.5%) patients were in SR at one month, AF recurrence was detected in 39 (32.5%) patients. In the AF group, AF duration, cardioversion energy, number of diabetic patients, left atrium (LA) diameter, LA pre-mitral A wave volume, LA minimum volume, and pulmonary artery pressure values were significantly higher than in the SR group, while mitral A wave velocity and LAKE values were significantly lower. In multivariate regression analysis, AF duration (OR: 1.54; 95% CI: 1.22 - 1.93; p < 0.001), LA diameter (OR: 1.33; 95% CI: 1.10 - 1.61; p = 0.002), and LAKE (OR: 0.96; 95% CI: 0.94 - 0.99; p = 0.007) were determined to be independent predictors of AF recurrence at one month. Conclusions LA diameter, AF duration, and LAKE were found to be significant predictors of AF recurrence after cardioversion.

The predictive value of hemoglobin to creatinine ratio for contrast-induced nephropathy in percutaneous coronary interventions.

OBJECTIVES: Hemoglobin and creatinine levels are important factors for contrast induced nephropathy (CIN) development. Our aim in this study is to investigate the predictive value of hemoglobin to creatinine ratio for CIN development in patients with percutaneous coronary intervention (PCI). METHODS: A total of 500 patients who underwent PCI in our clinic were evaluated prospectively in terms of CIN. Hemoglobin to creatinine ratio is calculated as baseline hemoglobin/baseline serum creatinine value. glomerular filtration rate (GFR) was calculated with Cockcroft-Gault formula. The definition of CIN includes absolute (≥0.5 mg/dL) or relative increase (≥25%) in serum creatinine at 48-72 h after exposure to a contrast agent compared to baseline serum creatinine values. RESULTS: CIN was detected in 13.8% (69 patients) of 500 patients. In multivariate lineer regression analysis, hemoglobin to creatinine ratio (beta: -0.227, p=0.03) and ejection fraction (EF) (beta: -0.161, p<0.001), contrast amount used (beta: 0.231, p<0.001) were found to be significant predictors for the development of CIN. In receiver operating characteristics (ROC) analysis; AUC=0.730 (0.66-0.79) for hemoglobin to creatinine ratio, p<0.001, AUC=0.694 (0.62-0.76) for EF, p<0.001 and AUC=0.731 (0.67-0.78) for contrast amount used p<0.001. CONCLUSIONS: Hemoglobin to creatinine ratio, EF and contrast amount used were independent predictors for CIN development in patients with PCI (NCT04703049).

The effect of whole blood viscosity on contrast-induced nephropathy development in patients undergoing percutaneous coronary intervention.

OBJECTIVE: In our study, we aimed to investigate how whole blood viscosity (WBV) affects the development of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). METHODS: In our study, 500 patients who applied to the cardiology clinic and underwent PCI for elective procedure, ST segment elevation myocardial infarction (STEMI), and non-STEMI were prospectively included. Before the procedure, we calculated WBV using the formula [(0.12× hematocrit) + (0.17×(total protein - 2.07)]. We defined CIN as the absolute (≥0.5 mg/dl) or relative increase (≥25%) in serum creatinine 48-72 h after exposure to a contrast agent compared with baseline serum creatinine values. RESULTS: CIN was developed in 69 (13.6%) of the 500 patients in the study. PCI was performed in 206 patients (41.2%) electively, 175 (35%) due to non-STEMI, and 119 (23%) due to STEMI. CIN was observed in 20.2% of the STEMI group, 13.7% of the non-STEMI group, and 10.2% of the elective PCI group. Multivariate logistic regression analysis results show that the independent predictors of CIN are low ejection fraction [OR:0.95 (95% CI:0.92-0.97); p < 0.001], low glomerular filtration rate [OR:0.96 (95% CI:0.95-0.98); p < 0.001], and increased amount of contrast agent [OR:1.008 (95% CI:1.004-1.01); p < 0.001]. When all patients were examined, no significant relationship was found between WBV and CIN. However, in the subgroup evaluation, it was concluded that low WBV was an independent predictor in elective PCI patients [OR:0.60 (95% CI:0.36-0.99); p = 0.04] for CIN. CONCLUSION: We found that low WBV was an independent predictor of CIN in patients undergoing elective PCI(NCT04703049).

Transcatheter treatment of partial anomalous pulmonary venous connection to left subclavian vein.

Reports of transcatheter treatment for dual drainage of an abnormal pulmonary venous connection are rare. Presently described is the case of a 27-year-old female with exertional dyspnea and a partial anomalous pulmonary venous connection of the left upper pulmonary vein with dual drainage to a vertical vein (VV) and the left atrium. The patient was evaluated with a balloon occlusion test to determine whether closing the anomalous VV connection would increase pulmonary pressure. The results of this test are an important guide to treatment decisions. A 12x9 mm Amplatzer Vascular Plug II device was successfully used to occlude the anomalous pulmonary venous connection using a transcatheter technique. This is a less invasive option than surgical repair and can be an appropriate choice in suitable cases.

A pulmonary arteriovenous malformation treated with percutaneous intervention.

A pulmonary arteriovenous malformation (PAVM) is a rare anomaly that may have significant clinical complications. PAVMs are commonly seen in patients with hereditary hemorrhagic telangiectasia, while some 10% of PAVMs may be idiopathic. PAVMs can cause cyanosis, fatigue, polycythemia, and paradoxical thromboembolic complications. The diagnosis and treatment of a PAVM should be performed with great care, as the disorder may be fatal if not properly treated. Percutaneous closure (such as embolization) can be very beneficial. Presently described is the case of a 23-year-old man with an idiopathic PAVM who was treated percutaneously with 3 vascular plugs.

The impact of cardiac rhythm on the mitral valve area and gradient in patients with mitral stenosis.

OBJECTIVE: The aim of this study was to evaluate the effect of cardiac rhythm on the echocardiographic mitral valve area (MVA) and transmitral gradient calculation in relation to net atrioventricular compliance (Cn). METHODS: Patients (n=22) with mild or moderate pure rheumatic mitral stenosis (MS) (MVA <2 cm2 and MVA >1 cm2) and atrial fibrillation (AF) were evaluated. All patients underwent transthoracic electrical DC cardioversion under amiodarone treatment. Nineteen of the 22 patients were successfully converted to sinus rhythm (SR). The patients were evaluated with transthoracic echocardiography before and two to three days after DC cardioversion. In order to deal with variable R-R intervals, the measurements were averaged on five to eight consecutive beats in AF. Cn was calculated with a previously validated equation [Cn (mL/mm Hg)=1.270 x MVA/E-wave downslope]. The Cn difference between AF and SR was calculated as follows: [(AF Cn-SR Cn)/AF Cn] x 100. The percentage gradient (mean or maximal) difference between AF and SR was calculated as follows: [AF gradient (mean or maximal) - SR gradient (mean or maximal)]/[AF gradient (mean or maximal)] x 100. RESULTS: The MVA was lower (MVA planimetric; 1.62±0.29 vs. 1.54±0.27; p=.003, MVA PHT; 1.66±0.30 vs. 1.59±0.26; p=0.01) but transmitral gradient (mean gradient; 6.49±2.51 vs. 8.89±3.52; p=0.001, maximal gradient: 16.94±5.11 vs. 18.57±4.54; p=0.01) and Cn values (5.37±0.77 vs. 6.26±0.64; p<0.001) were higher in the AF than SR. There was a significant correlation between Cn difference and transmitral gradient difference (mean and maximal) (Cn difference-mean gradient difference; r=0.46; p=0.05; Cn difference-maximal gradient difference; r=0.72; p=0.001). CONCLUSION: Cardiac rhythm has a significant impact on echocardiographic evaluation of MVA, transmitral gradient, and Cn in patients with MS.

Atrial Strain and Strain Rate: A Novel Method for the Evaluation of Atrial Stunning / Strain Atrial e Strain Rate: Novo Método para Avaliar Atordoamento Atrial

Abstract Background: Atrial fibrillation (AF) is the most common arrhythmia seen in adults. Atrial stunning is defined as the temporary mechanical dysfunction of the atrial appendage developing after AF has returned to sinus rhythm (SR). Objectives: We aimed to evaluate atrial contractile functions by strain and strain rate in patients with AF, following pharmacological and electrical cardioversion and to compare it with conventional methods. Methods: This study included 41 patients with persistent AF and 35 age-matched control cases with SR. All the AF patients included in the study had transthoracic and transesophageal echocardiography performed before and after. Septum (SEPsSR), left atrium (LAsSR) and right atrium peak systolic strain rate (RAsSR) were defined as the maximum negative value during atrial contraction and septum (SEPε), left atrium (LAε) and right atrium peak systolic strain (RAε) was defined as the percentage of change. Parameters of two groups were compared. Results: In the AF group, 1st hour and 24th hour LAε, RAε, SEPε, LAsSR, RAsSR, SEPsSR found to be significantly lower than in the control group (LAε: 2.61%±0.13, 3.06%±0.19 vs 6.45%±0.27, p<0.0001; RAε: 4.03%±0.38, 4.50%±0.47 vs 10.12%±0.64, p<0.0001; SEPε: 3.0%±0.22, 3.19%±0.15 vs 6.23%±0.49, p<0.0001; LAsSR: 0.61±0.04s-1, 0.75±0.04s- 1 vs 1.35±0.04s-1, p<0.0001; RAsSR: 1.13±0.06s-1, 1.23±0.07s-1 vs 2.10±0.08s- 1, p<0.0001; SEPsSR: 0.76±0.04s- 1, 0.78±0.04s- 1 vs 1.42±0.06 s- 1, p<0.0001). Conclusion: Atrial strain and strain rate parameters are superior to conventional echocardiographic parameters for the evaluation of atrial stunning in AF cases where SR has been achieved.

Resumo Fundamento: A fibrilação atrial (FA) é a arritmia mais comum em adultos. Define-se atordoamento atrial como a disfunção mecânica temporária do apêndice atrial que se desenvolve depois de reversão da FA ao ritmo sinusal (RS). Objetivos: Avaliar as funções atriais contráteis através de strain atrial e strain rate em pacientes com FA, após cardioversão farmacológica e elétrica, assim como compará-los com os métodos convencionais. Métodos: Este estudo incluiu 41 pacientes com FA persistente e 35 controles com RS e pareados por idade. Todos os pacientes com FA incluídos neste estudo foram submetidos a ecocardiografia transtorácica e transesofágica antes e após. Strain rates de pico sistólico do septo (SEPsSR), do átrio esquerdo (LAsSR) e do átrio direito (RAsSR) foram definidas como o máximo valor negativo durante contração atrial. Strains de pico sistólico do septo (SEPε), do átrio esquerdo (LAε) e do átrio direito (RAε) foram definidas como porcentagem de mudança. Resultados: No grupo com FA, os parâmetros LAε, RAε, SEPε, LAsSR, RAsSR e SEPsSR da 1a hora e da 24a hora foram significativamente mais baixos que no grupo controle (LAε: 2,61%±0,13; 3,06%±0,19 vs 6,45%±0,27; p<0,0001; RAε: 4,03%±0,38; 4,50%±0,47 vs 10,12%±0,64; p<0,0001; SEPε: 3,0%±0,22; 3,19%±0,15 vs 6,23%±0,49; p<0,0001; LAsSR: 0,61±0,04s-1; 0,75±0,04s-1 vs 1,35±0,04s-1; p<0,0001; RAsSR: 1,13±0,06s-1; 1,23±0,07s-1 vs 2,10±0,08s-1; p<0,0001; SEPsSR: 0,76±0,04s-1; 0,78±0,04s-1 vs 1,42±0,06 s-1; p<0,0001). Conclusão: Os parâmetros strain atrial e strain rate são superiores aos parâmetros ecocardiográficos convencionais para avaliar atordoamento atrial em pacientes com FA que reverteram ao RS.

Atrial Strain and Strain Rate: A Novel Method for the Evaluation of Atrial Stunning.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia seen in adults. Atrial stunning is defined as the temporary mechanical dysfunction of the atrial appendage developing after AF has returned to sinus rhythm (SR). OBJECTIVES: We aimed to evaluate atrial contractile functions by strain and strain rate in patients with AF, following pharmacological and electrical cardioversion and to compare it with conventional methods. METHODS: This study included 41 patients with persistent AF and 35 age-matched control cases with SR. All the AF patients included in the study had transthoracic and transesophageal echocardiography performed before and after. Septum (SEPsSR), left atrium (LAsSR) and right atrium peak systolic strain rate (RAsSR) were defined as the maximum negative value during atrial contraction and septum (SEPε), left atrium (LAε) and right atrium peak systolic strain (RAε) was defined as the percentage of change. Parameters of two groups were compared. RESULTS: In the AF group, 1st hour and 24th hour LAε, RAε, SEPε, LAsSR, RAsSR, SEPsSR found to be significantly lower than in the control group (LAε: 2.61%±0.13, 3.06%±0.19 vs 6.45%±0.27, p<0.0001; RAε: 4.03%±0.38, 4.50%±0.47 vs 10.12%±0.64, p<0.0001; SEPε: 3.0%±0.22, 3.19%±0.15 vs 6.23%±0.49, p<0.0001; LAsSR: 0.61±0.04s-1, 0.75±0.04s- 1 vs 1.35±0.04s-1, p<0.0001; RAsSR: 1.13±0.06s-1, 1.23±0.07s-1 vs 2.10±0.08s- 1, p<0.0001; SEPsSR: 0.76±0.04s- 1, 0.78±0.04s- 1 vs 1.42±0.06 s- 1, p<0.0001). CONCLUSION: Atrial strain and strain rate parameters are superior to conventional echocardiographic parameters for the evaluation of atrial stunning in AF cases where SR has been achieved.

A Novel Index Combining Diastolic and Systolic Tissue Doppler Parameters for Prediction of Atrial Fibrillation Recurrence.

OBJECTIVE: Identification of patients at risk for atrial fibrillation (AF) recurrence with using simple and objective parameters may be helpful in tailoring the treatment. In this study, we investigated whether E/(Ea×Sa) and Ea/(Aa×Sa) could be a predictor of AF recurrence after cardioversion. (E = early diastolic transmitral velocity, Ea = early diastolic mitral annular velocity, Aa = late diastolic mitral annular velocity, Sa = systolic mitral annular velocity). METHODS: In total, 127 patients with persistent AF were evaluated for this study and 73 patients were included according to the study criteria. Sinus rhythm (SR) was achieved for 70 patients after electrical direct-current cardioversion. E, Sa, Ea, and Aa were determined at mitral medial and lateral site and average values obtained. E/(Ea×Sa) and Ea/(Aa×Sa) were calculated (medial, lateral, average). Heart rate and rhythm were followed with an electrocardiography (ECG) monitor and 12-lead ECG at first week and first month. RESULTS: At one month, 53 patients (75.7%) were in SR, whereas 17 patients (24.3%) reverted to AF. According to precardioversion E/(Ea×Sa) lateral, E/(Ea×Sa) medial, E/(Ea×Sa) average (P ≤ 0.01 for all the indices), 24-hour echocardiographic evaluation E/(Ea×Sa) lateral, E/(Ea×Sa) medial, E/(Ea×Sa) average, Ea/(Aa×Sa) lateral, Ea/(Aa×Sa) medial, and Ea/(Aa×Sa) average (P ≤ 0.01 for all the indices), indices were significantly higher in the AF recurrence group than in the SR group. Furthermore, the ROC analysis showed that all the E/(Ea×Sa) and Ea/(Aa×Sa) parameters predict the AF recurrence. The AUC values range from 70% to 81% (P ≤ 0.01 for all the parameters). In subgroup analysis of the patients, precardioversion mitral medial E/Ea ratio was between 8 and 15, and the ROC analysis showed that the novel indices predict the AF recurrence. The AUC values range from 72% to 86% (P ≤ 0.02 for all the parameters). CONCLUSIONS: We found that E/(Ea×Sa) and Ea/(Aa×Sa) indices are novel predictors of AF recurrence.

Should we wait until severe pulmonary hypertension develops? Efficacy of percutaneous mitral balloon valvuloplasty in patients with severe pulmonary hypertension: A subgroup analysis of our experience.

BACKGROUND: The primary goal of this study is to evaluate the immediate and long-term ef-fects of percutaneous mitral balloon valvuloplasty (PBMV) on patients with rheumatic mitral stenosis (MS) complicated with severe pulmonary hypertension (PH). METHODS: The study population consisted of 85 patients with MS complicated with severe PH (systolic pulmonary pressure > 75 mm Hg). PBMV was performed with Inoue balloon technique. Clinical and echocardiographic follow-up was scheduled at 6 months and 1 year and yearly thereafter. RESULTS: Mitral valve area (MVA) was increased (pre-PBMV MVA was 1.03 ± 0.21 cm2, post-PBMV MVA 1.89 ± 0.34 cm2, p < 0.001) significantly. The mean and the maximum transmitral pressure gradient significantly decreased (pre-PBMV mean transmitral gradient was 18.47 ± 6.59 mm Hg, post-PBMV 6.84 ± 3.84 mm Hg, p < 0.001, pre-PBMV maximum transmitral pressure gradient was 27.6 ± 8.38 mm Hg, post-PBMV 12.68 ± 4.74 mm Hg, p < 0.001). Systolic pulmonary artery pressure (SPAP) significantly decreased (pre-PBMV 89.9 ± 23.38 mm Hg, post-PBMV 54.5 ± 14.6 mm Hg, p < 0.001). Two patients underwent surgery due to rupture of anterior mitral leaflet. There was no peri-procedural mortality. The procedure time was 29.12 ± 11.37 min. Follow-up duration was 108.2 ± 31.4 months. One patient died due to heart failure. One patient underwent re-PBMV and 7 patients mitral valve replacement. At the last follow-up, MVA still remained high (1.52 ± 0.34 cm2) and mean transmitral pressure gradient was low (9.2 ± 5.7 mm Hg). SPAP was 56.5 ± 20.8 mm Hg which was the same as after PBMV. CONCLUSIONS: PBMV in patients with MS with severe PH is an effective therapy with low procedure time. However, it is recommended to perform PBMV before developing severe PH.

Predictors of Atrial Fibrillation Recurrence in Hyperthyroid and Euthyroid Patients / Preditores de Recorrência de Fibrilação Atrial em Pacientes com Eutireoidismo e Hipertireoidismo

Background: Atrial fibrillation (AF) is the most common arrhythmia in adults, and is encountered in 10-15% of the patients with hyperthyroidism. Unless euthyroidism is restored, pharmacological or electrical cardioversion is controversial in patients with AF who remain hyperthyroid. Objective: The aim of this study was to assess the efficacy of electrical cardioversion and predictors of AF recurrence in hyperthyroid and euthyroid patients. Methods: The study included 33 hyperthyroid (21 males) and 48 euthyroid (17 males) patients with persistent AF. The patients were sedated with intravenous midazolam before undergoing electrical cardioversion delivered by synchronized biphasic shocks. Rates of AF recurrence were recorded. Results: Mean follow-up was 23.63 ± 3.74 months in the hyperthyroid group and 22.78 ± 3.15 months in the euthyroid group (p = 0.51). AF recurred in 14 (43.8%) and 21 (44.7%) patients in each group, respectively (p = 0.93). Multivariate regression analysis in each group showed that AF duration was the only predictor of AF recurrence, with odds ratios of 1.38 (95% confidence interval [CI] = 1.05 - 1.82, p = 0.02) in the hyperthyroid group and 1.42 (95% CI = 1.05 - 1.91, p= 0.02) in the euthyroid group. Conclusion: Rates of long-term AF recurrence were similar in successfully cardioverted hyperthyroid and euthyroid patients. The only predictor of AF recurrence in both groups was AF duration.

Fundamento: A fibrilação atrial (FA) é a arritmia mais comum em adultos e é encontrada em 10-15% dos pacientes com hipertireoidismo. A menos que haja retorno ao eutireoidismo, a cardioversão farmacológica ou elétrica é controversa em pacientes com FA que permanecem com hipertireoidismo. Objetivo: O objetivo deste estudo foi avaliar a eficácia da cardioversão elétrica e os preditores de recorrência de FA em pacientes com hipertireoidismo e eutireoidismo. Métodos: O estudo incluiu pacientes com FA persistente, dos quais 33 (21 homens) apresentavam hipertireoidismo e 48 (17 homens) eutireoidismo. Os pacientes foram sedados com midazolam endovenoso antes de serem submetidos à cardioversão elétrica com choques sincronizados bifásicos. As taxas de recorrência da FA foram registradas. Resultados: O tempo médio de seguimento foi de 23,63 ± 3,74 meses no grupo com hipertireoidismo e 22,78 ± 3,15 meses no grupo com eutireoidismo (p = 0,51). A FA recorreu em 14 (43,8%) e 21 (44,7%) pacientes em cada grupo, respectivamente (p = 0,93). Uma análise de regressão multivariada em cada grupo mostrou que a duração da FA foi o único preditor de recorrência de FA com odds ratios de 1,38 (intervalo de confiança [IC] 95% = 1,05 - 1,82, p = 0,02) no grupo com hipertireoidismo e 1,42 (IC 95% = 1,05 - 1,91, p = 0,02) no grupo com eutireoidismo. Conclusão: As taxas de recorrência da FA a longo prazo foram semelhantes em pacientes com hipertireoidismo e eutireoidismo submetidos com sucesso à cardioversão. A duração da FA foi o único preditor de recorrência da FA em ambos os grupos.

Predictors of Atrial Fibrillation Recurrence in Hyperthyroid and Euthyroid Patients.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia in adults, and is encountered in 10-15% of the patients with hyperthyroidism. Unless euthyroidism is restored, pharmacological or electrical cardioversion is controversial in patients with AF who remain hyperthyroid. OBJECTIVE: The aim of this study was to assess the efficacy of electrical cardioversion and predictors of AF recurrence in hyperthyroid and euthyroid patients. METHODS: The study included 33 hyperthyroid (21 males) and 48 euthyroid (17 males) patients with persistent AF. The patients were sedated with intravenous midazolam before undergoing electrical cardioversion delivered by synchronized biphasic shocks. Rates of AF recurrence were recorded. RESULTS: Mean follow-up was 23.63 ± 3.74 months in the hyperthyroid group and 22.78 ± 3.15 months in the euthyroid group (p = 0.51). AF recurred in 14 (43.8%) and 21 (44.7%) patients in each group, respectively (p = 0.93). Multivariate regression analysis in each group showed that AF duration was the only predictor of AF recurrence, with odds ratios of 1.38 (95% confidence interval [CI] = 1.05 - 1.82, p = 0.02) in the hyperthyroid group and 1.42 (95% CI = 1.05 - 1.91, p= 0.02) in the euthyroid group. CONCLUSION: Rates of long-term AF recurrence were similar in successfully cardioverted hyperthyroid and euthyroid patients. The only predictor of AF recurrence in both groups was AF duration.

The Evaluation of Type 2 Diabetes Mellitus Related Changes in Diastolic Dysfunction During Exercise Using Conventional and Tissue Doppler Echocardiography.

BACKGROUND: The aim of this study was to evaluate the relationship between changes in diastolic functions during exercise and the exercising capacity in diabetic patients with diastolic dysfunction and to compare them with healthy individuals and diabetic patients without diastolic dysfunction. METHODS: Totally 70 patients prospectively were included in the study and three groups were formed. Forty-six diabetic patients were divided into two groups: those with (group 1) and without (group 2) diastolic dysfunction. The control group (group 3) consisted of 24 patients. All patients were subjected to treadmill exercising test. Echocardiographical assessment was made before exercise and immediately after peak exercise. RESULTS: Exercising time was dramatically decreased in group 1 compared to the other groups (group 1: 396 ± 125 second, group 2: 487 ± 66 second and group 3: 519 ± 102 second). In group 1, the diastolic mitral flow pattern at rest was transformed into pseudo-normal pattern at peak exercise from abnormal relaxation pattern (E/A ratio 0.70 ± 0.11 during rest, 1.02 ± 0.16; P < 0.0001 during peak exercise). Deceleration time (DT) and iso-volumetric relaxation time (IVRT) turned to normal values (DT 238.86 ± 39.48 millisecond during rest and 199.5 ± 23.57 millisecond during peak exercise; P = 0.001, IVRT 102.83 ± 16.22 millisecond during rest and 74.36 ± 8.67 millisecond during peak exercise; P = 0.001). In groups 2 and 3, the mitral flow pattern, DT and IVRT remained within normal limits during rest and exercise. E/Em ratio, which is one of the parameters of tissue Doppler, increased during peak exercise in the diabetic group with diastolic dysfunction (E/Em ratio 7.85 ± 3.31 during rest and 11.14 ± 3.40 after peak exercise; P < 0.0001). CONCLUSIONS: Diabetic patients with diastolic dysfunction demonstrated a reduced exercise capacity, which may be due to aggravation of pre-existing left ventricular dysfunction.

Agenesis of the mitral posterior leaflet in elderly.

Congenital mitral valve regurgitation is a rare disease that is found in infancy and childhood, and sometimes in elderly people. In the case presented, mitral regurgitation that was tolerated well until the sixth decade of life is reported. A 62-year-old male suffering from dyspnea was referred to our hospital. Transthoracic echocardiographic examination demonstrated severe mitral regurgitation with suspicion of agenesis of the posterior leaflet with a long, mobile anterior leaflet. A transesophageal echocardiogram and surgical evaluation verified agenesis of the posterior mitral valve. The patient was successfully treated using mitral valve replacement, and no complications occurred.

The REDUCED (a RandomisED stUdy Comparing standard systemic anticoagulation thErapy to low Dose intracoronary anticoagulation therapy for elective percutaneous coronary intervention) trial. A novel pharmacologic regime for elective percutaneous coronary intervention.

AIM: This study tried to determine the efficacy and safety of low-dose intracoronary unfractionated heparin (UFH) in elective percutaneous coronary intervention (PCI). METHODS: Two-hundred patients who underwent elective PCI of an uncomplicated lesion were included into the study. The patients were assigned to either a control group (70-100 IU/kg intravenous UFH) or a low-dose intracoronary UFH (1,000 IU intracoronary UFH) group. RESULTS: At 30 days, the primary end point (composite of death, myocardial infarction, or urgent target vessel revascularization) was similar in both groups [intracoronary UFH group, 1.0%; control group, 2.0%; odds ratio; 0.49 (95% CI: 0.04 - 5.54), P = 0.56]. Post-procedural myocardial injury (according to CK-MB, P = 0.91; according to Tn I, P = 0.81) and bleeding events (based on TIMI criteria, P = 0.33; based on STEEPLE criteria, P = 0.20) were similar in the control and intracoronary groups. The primary end point at 6 months was also similar between the two groups (P = 0.33). Moreover, the health care cost at 30 days of follow-up was lower in the intracoronary group than in the control group (1,016 ± 54 $/patient vs 1,110 ± 102 $/patient, P < 0.001). CONCLUSION: This pilot study suggests that elective PCI could be safely performed with low-dose intracoronary UFH in the treatment of uncomplicated lesions and at a lower cost as compared to standard systemic anticoagulation.These results should be confirmed by further studies.