Predictors of Impaired Reperfusion after Percutaneous Coronary Intervention in Patients with In-Hospital Acute Stent Thrombosis: A Retrospective Analyses of 5 Years of Data.

BACKGROUND: Acute stent thrombosis (STh) is a rare complication of percutaneous coronary intervention (PCI) and is associated with a high-risk of reperfusion failure. However, data focusing on risk factors of reperfusion failure in patients undergoing repeat PCI for treatment of STh remains inadequate. METHODS: A total of 8815 patients who underwent PCI with stent implantation from January 2009 to December 2013 were retrospectively reviewed. Among those cases, patients that presented with acute STh and underwent a repeat PCI for acute STh were identified. RESULTS: There were 108 patients who underwent repeat PCI for the treatment of in-hospital acute STh that were retrospectively analyzed. Of these study subjects, 21 (25%) had thrombolysis in myocardial infarction (TIMI) flow < 3 after repeat PCI. The median value of pain-to-balloon time was 40 minutes in the TIMI < 3 group, 35 minutes in the TIMI = 3 group (p < 0.001), and the first PCI-to-stent thrombosis time was also longer in the TIMI < 3 group (10 hours vs. 2.5 hours, p = 0.001). When patients were evaluated according to PCI time, the percentage of patients with TIMI < 3 was significantly higher in the night period compared to the daytime period (46.4% vs. 17.5 %, p = 0.002). In the multivariable logistic regression analysis, stent length [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.008-1.38] and pain-to- balloon time (OR = 1.28, 95% CI, 1.06-1.54) were the only independent predictors of failed reperfusion. CONCLUSIONS: Baseline stent length and pain-to-balloon time were associated with reperfusion failure in PCI for STh. Moreover, TIMI flow grade showed a circadian variation.

Evaluation of left ventricular systolic function with pulsed wave tissue Doppler in rheumatic mitral stenosis.

BACKGROUND: Mitral stenosis (MS) is still the most common complication of acute rheumatic fever in Turkey. Rheumatic carditis affects not only cardiac valves but also myocardium. In this study, we aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction and contraction of short and long axial circumferential and longitudinal fibers by pulsed wave tissue Doppler in rheumatic MS patients who have preserved LV systolic function in 2D echocardiography. METHODS: Fifteen severe, 20 moderate rheumatic MS patients hospitalized for mitral balloon valvuloplasty, and 15 patients who had normal echocardiographic findings were included in the study. After routine conventional transthoracic echocardiographic examination, LV myocardial systolic velocities were evaluated with pulsed wave tissue Doppler in the short and long axis with simultaneous electrocardiographic monitoring. RESULTS: Long axis first systolic velocity (SW1) of mild-moderate and severe MS was much lower than normal group (10.7 ± 2.3 in normal group vs. 7.9 ± 1.3 in mild-moderate MS group vs. 6.2 ± 1.4 in severe MS group, p < 0.001). Long axis Q-SW1 duration was longer in mild-moderate MS group (145 ± 32 in normal group vs. 199 ± 43 in mild-moderate MS group, p = 0.001). Short axis Q-SW2 duration was longer in normal group compared to mild-moderate and severe MS groups (298 ± 41 in normal group vs. 245 ± 37 in mild-moderate MS group vs. 234 ± 26 in severe MS group, p < 0.001). Significant correlation between mitral valve area and SW1, Q-SW1 was determined (p = 0.01). CONCLUSIONS: Even if LV functions are normal with conventional 2D echocardiography, subclinical systolic dysfunction exists in MS. Also, there is a dyssynchrony between contraction of longitudinal and circumferential myofibrils.

Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism.

Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 ± 15 years. The mean follow-up duration was 11 ± 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p = 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE.

A case of rhabdomyolysis and thromboembolic event secondary to fibrate monotherapy.

Fibrates either alone or in combination with statins have been commonly used for the treatment of high non-HDL-cholesterol levels. In addition, this type of therapy is also associated with some adverse events like rhabdomyolysis. We present the first case in the literature describing the development of both rhabdomyolysis-induced acute renal failure and thromboembolic event under the treatment of fibrate monotherapy.

[A rare cause of pulmonary hypertension: pulmonary Langerhans cell granulomatosis]. / Pulmoner hipertansiyonunun nadir bir nedeni: Pulmoner Langerhans hücreli granülomatozis.

Pulmonary Langerhans cell granulomatosis (PLCG) is a smoking-related interstitial lung disease characterized by hyperinflation and/or obstructive pulmonary disease. Pulmonary hypertension is a late complication of advanced pulmonary disease and often portends a poor prognosis. A 24-year-old male patient who had been receiving diltiazem and corticosteroid treatment with the diagnosis of PLCG for four years was examined by the cardiology clinic due to dyspnea and deterioration in his functional capacity. He was in New York Heart Association class III. The electrocardiogram showed sinus rhythm and right bundle branch block. Systolic pulmonary artery pressure (SPAP) was estimated as 80 mmHg with continuous-wave Doppler echocardiography. During right heart catheterization, SPAP was 70 mmHg and the mean pulmonary artery pressure (MPAP) was 44 mmHg. Vascular pulmonary reactivity test with adenosine did not result in a significant change in MPAP. Based on these findings, medical treatment was scheduled for the patient.