Coronary sinus collapsibility index and inferior vena cava collapsibility index can predict right atrial pressure in patients undergoing right heart catheterization.

BACKGROUND: The aim of the study is to investigate the relationship between the diameters and collapsibility indices of coronary sinus (CS) and inferior vena cava (IVC) and invasively measured right atrial pressure (RAP), and to determine whether these parameters have predictive value on RAP. METHODS: A total of 136 patients undergoing right heart catheterization due to pulmonary arterial hypertension were included in the study prospectively. CS diameters, IVC diameters, CS collapsibility index (CSCI), and IVC collapsibility index (IVCCI) were measured by echocardiography before catheterization. Pearson correlation analysis was used to compare the parameters. Receiver operating characteristics (ROC) curve analysis was used to determine the predictive value of the CS and IVC collapsibility indices in predicting RAP. RESULTS: Patients were divided into two groups as invasively measured RAP≥10 mm Hg (n:57) and RAP < 10 mm Hg (n:79). In the group with RAP≥10 mm Hg, IVC and CS diameters were higher than in the group with RAP < 10 mm Hg, while the IVCCI and CSCI were lower (p < 0.001). A negative correlation was observed between CSCI and IVCCI and RAP. Also, a positive correlation was observed between CSCI and IVCCI. Optimal cut-off value for IVCCI was 46.1 with a sensitivity of 75%, and specificity of 79.7%. Optimal cut-off value for CSCI was 39.2 with a sensitivity of 75.4%, and specificity of 88.6%. CONCLUSION: CS and IVC diameters and collapsibility indices measured by echocardiography were found to be associated with invasively measured RAP, and may be used together for estimating RAP.

Transcatheter Coil Embolization in 17 Patients with 22 Coronary Artery Fistulas.

Coronary artery fistulas are rare anomalies that often become symptomatic with age. They are typically diagnosed incidentally during coronary angiography. The chief nonsurgical treatment is transcatheter coil embolization. We evaluated the outcomes of this procedure in 17 symptomatic patients who had 22 fistulas in total. The 9 men and 8 women (mean age, 52 ± 16.5 yr; range, 27-74 yr) presented at 4 Turkish hospitals from October 2008 through March 2015. Three patients had multiple fistulas. Twelve fistulas originated from the right coronary artery and 10 from the left coronary artery, draining into the pulmonary artery in 18 instances. We evaluated results postprocedurally and after 2 to 5 months, defining angiographic success as a flow better than Thrombolysis in Myocardial Infarction grade 2 in the treated artery. Twenty-one of the 22 procedures immediately produced the targeted flow. We observed 2 minor and no major complications. On follow-up, 3 symptomatic patients underwent successful repeat treatment of one fistula each. We found that transcatheter coil embolization afforded good success rates with few complications in closing coronary artery fistulas. We share our experience to add to the data on treating patients with coronary artery fistulas, and to raise awareness among clinicians.

Melatonin protects against streptozotocin-induced diabetic cardiomyopathy by the phosphorylation of vascular endothelial growth factor-A (VEGF-A).

The aim of the present study is to investigate if the melatonin has any protective effect on diabetic cardiomyopathy and antioxidant enzymes via phosphorylation of vascular endothelial growth factor-A (VEGF-A). A total of 40 male Wistar rats were enrolled in the study. Rats were divided into four groups: group 1 (control, n=10), group 2 (DM, n=10), group 3 (melatonin, n=10), and group 4 (melatonin+DM, n=10). Melatonin was injected intraperitoneally at a dose of 50 mg/kg/day for 56 days to group 3 and group 4. We investigated expression and phosphorylation of the VEGF-A in coronary vessels of all groups. Staining intensities, biochemical, immunohistochemistry analysis, and transthoracic echocardiography were performed. In comparison to the group 1, DM induced a decrease in p-VEGF-A in coronary vessels of group 2. The lower constitutive phosphorylation of VEGF-A in the group 2 was also increased in coronary vessels after melatonin treatment (p<0.05). Diabetic rats developed myocardial hypertrophy with preserved cardiac function (p<0.05). Cardio-protective effect of melatonin may reduce the damages of diabetes mellitus on the heart muscle fibers and coronary vessels via the phosphorylation of VEGF-A. Melatonin-dependent phosphorylation of VEGF-A in coronary angiogenesis may be associated with the physiological as well as with the pathological cardiac hypertrophy.

ST segment elevation myocardial infarction (STEMI) patients are more likely to achieve lipid-lowering treatment goals: A retrospective analysis of patients presenting with first acute coronary syndromes.

Statin nonadherence or discontinuation is associated with increased cardiovascular events. Many factors related to the physicians or the patients are influential in this. We aimed to compare the compliance with statin therapy between the patients who first presented with ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UA) based on the target achievement according to the current dyslipidemia guidelines.We retrospectively acquired all the information about demographic characteristics, in-hospital revascularization procedures, prescribed treatments, and index and up to 6-month follow-up laboratory results of the first acute coronary syndrome patients. Acute coronary syndrome patients were divided into 3 groups as STEMI, NSTEMI, and UA.The STEMI group consisted of 260 patients, NSTEMI group consisted of 560 patients, and UA group consisted of 206 patients. Seventy-six percent of patients underwent percutaneous coronary interventions, 18.3% were managed medically, and 5.7% were referred for coronary artery bypass grafting. There was a significant decrease in low-density lipoprotein-cholesterol (LDL-C) values with the statin treatment at the follow-up in all 3 groups (for all P < .001). In the STEMI group, the percentage of those achieving the target LDL-C level was significantly higher than those who did not achieve the target according to both The American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology dyslipidemia guidelines. The LDL-C target achievement rates were also higher in the STEMI group than in the NSTEMI and UA groups.Our study concluded that statin treatment goals were more attained in STEMI patients than NSTEMI and UA. All physicians should encourage lifelong intensive statin treatment in UA and NSTEMI patients such as STEMI patients.

Assessment of left atrial function using speckle tracking echocardiography in ankylosing spondylitis: a case-control study.

The aim of this study is to assess the left atrium (LA) deformation parameters by using 2D speckle tracking echocardiography (2D-STE) in ankylosing spondylitis (AS) patients and to evaluate the relationship between these parameters and AS clinical indexes. 30 patients with AS (22 males, 8 females) and 30 healthy individuals (19 males, 11 females) were enrolled in this study. Transthoracic echocardiography was performed to both groups. Besides the conventional echocardiographic parameters, the LA strain parameters; including systolic-reservoir (LA S-S), early diastolic-conduit (LA S-E), late diastolic-contraction (LA S-A) were measured. No significant difference was found between two groups in terms of conventional echocardiographic parameters except mean deceleration time (DT). Mean DT was prolonged in the AS patients compare with the control group (173.5 ± 22.5 vs. 155.3 ± 36.7, p = 0.025). In the AS patients, LA S-S (48.3 ± 9.4 vs. 56.9 ± 10.1, p = 0.001), LA S-E (26.4 ± 6.4 vs. 31.6 ± 7.3, p = 0.005) and LA S-A (21.9 ± 4.7 vs. 25.4 ± 5.7, p = 0.013) values were statistically lower than the control group. Also a negative correlation was observed between the Bath Ankylosing Spondylitis Metrology Index (BASMI) and LA S-S (r = - 0.509, p = 0.004), LA S-E (r = - 0.501, p = 0.005). Our study demonstrated that 2D-STE is a useful method to determine the left atrial involvement in AS patients without the clinical evident of cardiovascular disease.

Rupture of Sinus of Valsalva Aneurysm into Left Atrium in a Patient who is a Candidate for Hepatic Transplantation.

Sinus of valsalva aneurysm (SVA) is a rare cardiac disease. The most common complication of SVA is rupture into the right atrium or right ventricle. Rupture into the left chambers is very rare. Patients with ruptured SVA are likely to die of heart failure or endocarditis. We present a 29-year-old man who was hospitalized for hepatic transplantation with rupture of SVA. Transthoracic echocardiography and transesophageal echocardiography showed rupture of a noncoronary SVA into the left atrium. Mitral valve infective endocarditis developed and surgery was planned for the patient, but the patient died due to multiple organ dysfunction syndrome.

Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P-wave dispersion and P terminal force.

OBJECTIVE: Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on left atrial (LA) systolic and diastolic functions using two-dimensional speckle tracking echocardiography (2D-STE), P-wave dispersion (PWD), and P terminal force (PTF) in hypertensive patients. METHODS: A total of 72 patients and 39 healthy individuals were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Atrial electromechanical delay times, LA strain values were obtained by 2D-STE with automated software and compared between the groups. PWD and PTF data were calculated on the electrocardiography. RESULTS: Inter-atrial (dippers: 25.5 ± 3.9, nondippers: 32.2 ± 7.4, P < .001), left-atrial (dippers: 14.9 ± 3.7, nondippers: 18.2 ± 6.0, P = .016), and right atrial (dippers: 10.5 ± 2.1, nondippers: 14.2 ± 5.2, P < .001) electromechanical delay times were significantly longer in nondippers. LA strain S (dippers: 34.2 [29.7-38.7], nondippers: 27.7 [22.7-32.2], P < .001), LA strain E (dippers: 18.2 [16.6-20.1], nondippers: 14.4 [11.6-16.8], P < .001), and LA strain A (dippers: 15.8 [13.5-17.9], nondippers: 12.7 [9.9-14.5], P < .001) were significantly lower in nondippers. Nondippers also had an increased values of maximum P-wave duration (dippers: 0.117 [0.10-0.12], nondippers: 0.126 [0.12-0.14], P < .001), PWD (dippers: 0.062 [0.06-0.07], nondippers: 0.069 [0.06-0.08], P = .004), and PTF (dippers: 0.055 ± 0.02, nondippers: 0.066 ± 0.02, P = .02). CONCLUSION: Nondipping pattern in hypertensive patients had a worse cardiac remodeling, and impaired mechanical LA function compared with dipping pattern. The PWD and PTF findings support these changes.

Renal artery occlusion in the late postoperative period managed with renal artery stenting after endovascular abdominal aortic aneurysm repair and renal function salvage.

Endovascular aneurysm repair (EVAR) of abdominal aorta is a valuable treatment option in selected patients with abdominal aortic aneurysm. Renal artery occlusion is a serious complication after EVAR and may progress to permanent renal injury requiring hemodialysis. In this report, case of unexpected renal artery occlusion after EVAR treated with renal artery stenting in the late postoperative period is described.

[Congenitally corrected transposition of the great arteries in patient with atrial septal defect and acute inferior segment myocardial infarction]. / Ileri yasta akut inferiyor miyokart enfarktüsü ile basvuran ve atriyal septal defekt anomalisinin eslik ettigi dogumsal düzeltilmis büyük arter transpozisyonu.

Congenitally corrected transposition of the great arteries is a rare abnormality accounting for approximately 1% of clinically apparent congenital heart disease. Age at time of diagnosis and survival rate vary and depend on associated anomalies, including pulmonary stenosis, ventricular septal defect, atrial septal defect, atrioventricular block, and atrioventricular valve regurgitation. Reported cases of corrected transposition of the great arteries with single coronary ostium anomaly and atrial septal defect are very rare. Described in the present report is the case of a 55-year-old male who presented with acute inferior ST-segment elevation myocardial infarction and coincidental single coronary ostium arising from the right sinus of Valsalva, as observed on coronary angiography. Successful balloon angioplasty and stenting of the circumflex artery were performed. Echocardiography demonstrated the corrected transposition of the great arteries with negative contrast enhancement between the atrial chambers. The patient was discharged with medical therapy on the eighth postoperative day. To our knowledge, the present is the first report to describe corrected transposition of the great arteries, atrial septal defect, single coronary ostium, and acute myocardial infarction as comorbidities.

Red cell distribution width and neutrophil-to-lymphocyte ratio predict left ventricular dysfunction in acute anterior ST-segment elevation myocardial infarction.

OBJECTIVES: Red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) are the two markers used to determine risk of mortality and adverse cardiovascular outcomes in patients with acute myocardial infarction. The relationship between RDW, NLR, and left ventricular (LV) systolic functions has not been reported. In this report, we aimed to investigate the relationship between RDW, NLR, and LV systolic function in anterior ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PCI). METHODS: RDW and NLR were measured on admission in 106 STEMI patients treated with primary PCI. Patients were divided into two groups according to left ventricular ejection fraction (LVEF), as Group I (systolic dysfunction, LVEF <50%) and Group II (preserved global left ventricle systolic function, LVEF ⩾50%). The first group included 47 patients and the second group included 59 patients. RESULTS: Mean RDW and NLR were significantly higher in Group I compared to Group II [13.7 ± 0.9% vs. 13.4 ± 0.7%, p = 0.03 and 5.86 (range, 0.66-40.50) vs. 2.75 (range, 0.51-39.39), p = 0.013, respectively]. CONCLUSION: Increased RDW and NLR on admission, in anterior STEMI patients treated with primary PCI are associated with LV systolic dysfunction.