FIB-4 liver fibrosis index correlates with aortic valve sclerosis in non-alcoholic population.

AIM: Hepatic fibrosis, a progressive scarring of liver tissue, is commonly caused by non-alcoholic fatty liver disease (NAFLD), which increases the risk of cardiovascular disease. The Fibrosis-4 (FIB-4) index is a non-invasive tool used to assess liver fibrosis in patients with NAFLD. Aortic valve sclerosis (AVS), a degenerative disorder characterized by thickening and calcification of valve leaflets, is prevalent in the elderly and associated with increased cardiovascular morbidity and mortality. Recent studies have suggested that AVS may also be linked to other systemic diseases such as liver fibrosis. This study aimed to investigate the relationship between the FIB-4 index and AVS in a non-alcoholic population, with the hypothesis that the FIB-4 index could serve as a potential marker for AVS. METHOD: A total of 92 patients were included in this study. AVS was detected using transthoracic echocardiography, and patients were divided into groups according to the presence of AVS. The FIB-4 index was calculated for all patients and compared between the groups. RESULTS: A total of 17 (18.4%) patients were diagnosed AVS. Patients with AVS had higher rates of diabetes mellitus, older age, hypertension, angiotensin-converting enzyme inhibitor use, higher systolic blood pressure (BP) and diastolic BP in the office, coronary artery disease prevalence, left atrial volume index (LAVI), left ventricular mass index (LVMI), and late diastolic peak flow velocity (A) compared to those without AVS. Moreover, AVS patients had significantly higher creatinine levels and lower estimated glomerular filtration rate. Remarkably, the FIB-4 index was significantly higher in patients with AVS. In univariate and multivariate analyses, higher systolic BP in the office (OR, 1.044; 95% CI 1.002-1.080, p = .024) and higher FIB-4 index (1.46 ± .6 vs. .91 ± .46, p < .001) were independently associated with AVS. CONCLUSION: Our findings suggest that the FIB-4 index is associated with AVS in non-alcoholic individuals. Our results highlight the potential utility of the FIB-4 index as a non-invasive tool for identifying individuals at an increased risk of developing AVS.

Assessment of treatment patterns and patient awareness in atrial fibrillation patients using non-vitamin K antagonist oral anticoagulants (ASPECT-NOAC).

Background and Aim: Despite the advances in oral anticoagulation with NOACs, careful patient and dose selection is required with NOAC therapy. Our study aimed to assess treatment patterns of NOACs in AF along with patients' continuity to NOAC treatments in first year, and their knowledge level of AF and NOAC treatment. Methods: ASPECT-NOAC was designed as an observational, prospective, and multicenter study. AF patients who were prescribed NOACs within last four months were recruited from 34 outpatient cardiology clinics covering all geographic regions of Turkey. Baseline data were collected initially whereas patient awareness was evaluated at 3 to 4 weeks. Final study visit was performed at 12 months. Results: In total, 991 patients were included to the study. Mean ± standard deviation of age was 69.4 ± 10.2 years and 53.0% of patients were female. Mean duration from AF diagnosis was 24.9 ± 50.9 months. Mean CHA2DS2-VASc and HAS-BLED scores were 3.1 ± 1.5 and 1.6 ± 1.1, respectively. AF disease and NOAC treatment knowledge levels were found to be 48.9 ± 23.1% and 73.0 ± 19.3%, respectively. Among reduced dose users 71.4% of patients were prescribed inappropriate reduced doses. Through the study follow-up, 32 patients (3.2%) deceased and NOAC therapy was discontinued in 74 patients (8.7%). Conclusion: AF patients who recently started NOAC treatment in Turkey were found to have variable knowledge about their disease and anticoagulation treatment. It was observed that most of the patients continued the NOAC treatment throughout the study. Reduced dosing of NOACs was common, which was associated with higher baseline risk for bleeding as well as stroke.

Fragmented QRS predicted major adverse cardiovascular events in patients with coronary artery disease and percutaneous coronary intervention, 10-years of follow-up.

Aim    Identifying high-risk groups in patient with coronary artery disease (CAD) is critical for predicting future adverse events. fQRS has been shown to be related to major cardiovascular adverse events (MACE) in patients with CAD. However, predictive value of fQRS for more than 5 yrs has not been evaluated. This study examined the predictive value of fQRS in patients with CAD and percutaneous coronary intervention during a 10­yrs period.Material and methods    Patients with CAD and percutaneous coronary intervention between March 2007 and May 2009 were included the study. An electrocardiogram was recorded following percutaneous coronary intervention and analyzed for the presence of fQRS. The fQRS pattern was defined as an additional spike inside the QRS complexes of at least two consecutive leads. Patients were followed for 10 yrs. A MACE was all-cause mortality or new-onset decompensated heart failure. Patients were divided into two groups according to presence or absence of MACE, and their clinical variables were compared.Results    Of 1261 patients included in the study, MACE developed in 374 (29.6 %). MACE (+) patients were older (p<0.001), more likely to have diabetes mellitus (p=0.003), fQRS (p<0.001), and ST-elevated myocardial infarction (STEMI) (p<0.001). Multivariable Cox regression analysis revealed that age (p<0.001), STEMI (p=0.001), fQRS (p=0.017), and elevated serum creatinine (p=0.001) were independent predictors of MACE.Conclusion    The presence of fQRS predicted MACE during 10 yrs of follow-up of patients with CAD and percutaneous coronary intervention.

Left atrial volume index and pulmonary arterial pressure predicted MACE among patients with STEMI during 8-year follow-up: experience from a tertiary center.

BACKGROUND: It is important to identify patients that are at high risk following primary percutaneous coronary intervention (P-PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI). Left ventricular ejection fraction (LVEF) is the most important parameter obtained from transthoracic echocardiography (TTE) for risk stratification. The authors evaluated the value of pulmonary artery pressure (PAP) and left atrial volume index (LAVI) for the prediction of major adverse cardiovascular events (MACE) in patients with STEMI that underwent P­PCI. METHODS: A total of 92 patients that underwent P­PCI for STEMI were included in the study. All patients underwent TTE examination before discharge. The composite primary outcome of the study was all-cause mortality and new onset heart failure (HF) during an 8-year follow-up period. RESULTS: The mean age of patients was 61.6 ± 12.4 years and 15 were female (16.3%). Major adverse cardiovascular events (MACE) defined as all-cause mortality and new onset HF occurred in 30 (41%) patients during a mean of 6 ± 2.7 years of follow-up. In the backward multivariate Cox regression analysis LVEF (odds ratio [OR] = 0.933, 95% confidence interval [CI]: 0.876-0.994, p = 0.031), LAVI (OR = 1.069, 95%CI: 1.017-1.124, p = 0.009), PAP (OR = 1.137, 95% CI: 1.057-1.223, p = 0.001) and creatinine level (OR = 1.730, 95% CI: 1.350-1.223, p = 0.029) were found to independently predict MACE during long-term follow-up. Receiver operating characteristic (ROC) curve analysis was performed, revealing that sPAP >24.5 mm Hg had a sensitivity and specificity of 72 and 66%, respectively; LAVI >31 ml/m2 had a sensitivity and specificity of 72.2 and 83.3%, respectively. CONCLUSION: In patients that underwent P­PCI for the treatment for STEMI, LVEF, LAVI, PAP and creatinine level independently predicted all-cause mortality and new onset HF during long-term follow-up.

The role of serum interleukin-37 levels, inflammation and blood pressure in patients with preeclampsia.

AIM: Preeclampsia is one of the major causes of perinatal, fetal, and maternal mortality and morbidity. The aim of this study was to investigate the association of serum interleukin 37 (IL 37) with preeclampsia. METHODS: 39 women with preeclampsia were included as the study group. 38 healthy, and normotensive pregnant women, at similar gestational week with similar gravidity volunteered as the control group. Clinical findings, biochemical parameters, maternal and perinatal outcomes, and the serum concentrations of IL37 were compared between the groups. The relationship of IL 37 concentrations with clinical findings and blood pressure outcomes were also investigated. RESULTS: Maternal serum IL 37 concentrations were significantly higher in patients with preeclampsia compared to the healthy pregnant women in the control group (p = .005). IL 37 positively correlated systolic blood pressure (BP) (r = 0.344, p = .002), and diastolic BP (r = 0.332, p = .003). IL 37 was identified as an independent predictor of preeclampsia. CONCLUSIONS: Serum IL 37 concentrations were higher in preeclamptic patients compared to healthy pregnant women. Furthermore, IL 37 concentrations achieved success in identifying preeclampsia with hypertension. Increased IL 37 activity may have a role in the pathophysiology of preeclampsia.

An echocardiographic predictor of contrast-induced nephropathy following percutaneous coronary intervention in acute coronary syndrome: aortic valve sclerosis.

Objective. Aortic valve sclerosis (AVS) is closely related to endothelial dysfunction. The association of AVS with contrast-induced nephropathy (CIN) is unknown. We planned to investigate the relationship of AVS besides known parameters with CIN. Design. Baseline characteristics, biochemical values, and AVS of 292 consecutive patients with acute coronary syndrome (ACS) that underwent percutaneous coronary intervention (PCI) were analyzed. Results. Fifty-three patients (18.2%) had CIN. Patients with CIN were older, less likely to be smokers, and had more prevalent prior bypass surgery, higher Mehran score, creatinine, and uric acid concentrations than those without CIN. AVS was more prevalent in patients with CIN. Logistic regression analysis including all related parameters identified Mehran score (OR = 1.036, p = .033), uric acid concentration (OR = 1.244, p = .023), and AVS (OR: 2.223, p = .027) as independent predictors of CIN. Conclusion. AVS is independently associated with CIN in patients with acute coronary syndrome undergoing percutaneous coronary intervention. AVS may help to identify high-risk patients for CIN, who would benefit from preventive measures.

Elevated serum YKL40 level is a predictor of MACE during the long-term follow up in hypertensive patients.

Background: YKL-40 (human cartilage glycoprotein 39, chitinase-3-like protein 1) is an inflammatory marker secreted mainly by macrophages and has distinctive roles on extracellular matrix remodeling, macrophage maturation, adhesion, and migration. Despite the presence of robust data suggesting the association of YKL-40 with variety of cardiovascular diseases (CV), there is no study up to date evaluating the role of YKL-40 on the long-term prognosis in patients with hypertension (HT).Methods: A single center, prospective, observational cohort study that included 327 consecutive hypertensive patients which were presented to a cardiology outpatient clinic. Patients were followed up for 7.89 ± 0.12 years. Primary outcome of the study was the occurrence of major cardiovascular outcomes (MACE) defined as all-cause mortality, new onset heart failure (HF), and coronary artery disease (CAD) requiring revascularization.Results: A total of 135 patients constituted the final study population [mean age: 52.4 ± 10.2, female: 63 (46%)]. A total of 28 (20.7%) patients had MACE during the follow up. Cox regression analysis revealed that age (HR: 1.046, 1.016-1.093 CI 95%, p = .026), diabetes (HR: 2.278, 1.026-5.057 CI 95%, p = .043), and YKL-40 level (HR: 1.019, 1.013-1.026 CI 95%, p = .005) significantly predicted MACE. We found that sensitivity and specificity of YKL-40 > 93.5 for predicting MACE was 71.4% and 65%, respectively with an area under curve (AUC) 0.723 (0.617-0.828 CI 95%, p < .001)Conclusion: Elevated serum YKL-40 level predicted MACE in hypertensive patients during a long-term follow up.

Evaluation of serum apelin-13 and apelin-36 concentrations in preeclamptic pregnancies.

AIM: Recent studies suggest that apelin can be a novel potential therapeutic mediator to improve the diagnosis, and treatment of preeclampsia. This study aimed to investigate the association of serum apelin-13 and apelin-36 with preeclampsia and to detect their relationship with preeclampsia-associated perinatal morbidity. METHODS: Forty-four women with preeclampsia were included as the study group. Forty-four healthy pregnant women, at similar gestational week with similar gravidity, formed the control group. The clinical findings, biochemical indicators, maternal and perinatal outcomes, and the serum concentrations of apelin-36 and apelin-13 were evaluated. The levels of apelin-13 and apelin-36 were determined with commercial kits using a competition-based enzyme-linked immunosorbent assay method. RESULTS: The mean gestational age at sampling was 35.77 ± 2.515 weeks in the preeclamptic group, 36.45 ± 2.057 weeks in the control group (P = 0.270). Maternal serum apelin-36 and apelin-13 concentrations were significantly lower in patients with preeclampsia compared to the individuals in the control group (P = 0.030 and P = 0.005, respectively). The optimal cut-off points of apelin-36 and apelin-13 measurements for discriminating between preeclampsia and controls were evaluated by the receiver-operator curve analysis. The results showed that apelin-13 and apelin-36 are moderately successful markers to differentiate subjects with preeclampsia from healthy pregnant women. The concentrations of apelin-13 and apelin-36 in both groups were not statistically different in cases with and without adverse fetal/neonatal outcomes. CONCLUSION: In conclusion, we investigated serum apelin-13 and apelin-36 concentrations in preeclamptic patients and demonstrated markedly lower maternal concentrations compared to healthy pregnant women.

Hair whitening and obesity are independently related to ascending aorta dilatation in young-middle aged men.

OBJECTIVE: Hair whitening (HW) is strongly linked with aging. Ascending aortic dilation (AAD) and HW share common etiologic factors. We investigated the association of HW with ascending aortic diameters. METHODS: Our study included 93 male subjects aged below 50 years. All patients underwent echocardiography to measure ascending aortic diameter, in addition to routine biochemistry tests, physical examination, and thorough medical history. HW score (HWS) was defined according to the percentage of white hair (HWS 1: <25%; HWS 2: 25-50%; HWS 3: 50-75%; and HWS 4: 75-100). RESULTS: Patients with highest HWS were older and had a higher percentage of hypertension (HT) and family history of HW. Moreover, this subgroup had increased ascending aortic diameter, higher serum uric acid, and lower total bilirubin concentrations. Multivariate analyses including age, HT, height, waist circumference, c-reactive protein, and family history of HW identified body weight and HWS as the independent predictors of ascending aortic diameter. CONCLUSION: An independent association between the degree of HW and AAD exists in middle-aged men, which may depend on coexisting factors that enhance both pathologies rather than causality. We think that oxidative stress may be one of these stressors.

Epicardial Adipose Tissue Predicts Carotid Intima-Media Thickness Independently of Body Mass Index and Waist Circumference.

Background: Visceral obesity is strongly associated with atherosclerosis. Even though waist circumference (WC) is the most common assessment method of total visceral adipose tissue and cardiometabolic risk, this method lacks direct measurement of adipose tissue and has better correlation to subcutaneous fat rather than visceral fat. We intended to investigate whether epicardial adipose tissue (EAT) is clinically superior to body mass index (BMI) and WC in predicting Framingham risk score (FRS) and carotid intima-media thickness (CIMT). Methods: Our study included 331 patients who were admitted to our outpatient clinic for risk factor assessment. We calculated BMI, FRS, and WC, and the patients underwent echocardiographic and carotid examinations to measure EAT and CIMT. The metabolic syndrome (MS) score was calculated by summing the MS risk factor scores. Results: The area under the curve values of EAT were similar to FRS and higher than those of weight, BMI, and WC for both increased CIMT and the presence of carotid plaque. Male gender, age, low-density lipoprotein-cholesterol level, and EAT thickness were independent predictors of CIMT, whereas male gender, age, WC, uric acid concentration, and EAT significantly predicted the presence of carotid plaque. Conclusions: This study demonstrated that epicardial adipose tissue (EAT) has a stronger correlation with CIMT than BMI and WC, and it was a significant predictor of increased CIMT and the presence of carotid plaque. Additional data are required to clarify the diagnostic and therapeutic role of EAT in managing obese patients, and to decrease their cardiometabolic risk.

The Relationship between Serum Apelin Levels and the Severity of Calcific Aortic Stenosis.

Background: Apelin, an endogenous peptide, has recently gained attention due to its positive inotropic effects in heart failure physiopathology. We investigated the relationship between serum apelin levels and the severity of calcific aortic stenosis (AS). Methods: A total of 68 consecutive patients diagnosed with calcific AS and a control group of 32 subjects were included in the study. The subjects were divided into three group as follows: the control group, the mild-moderate AS group and the severe AS group. Blood samples were obtained from all of the subjects, which were used for biochemical comparisons of apelin 36 and high-sensitive C-reactive protein (hsCRP) levels. Results: Plasma apelin 36 levels were significantly lower in the patients with severe AS [490 (247-1074) pg/ml] compared to both the mild-moderate AS [209 (97-453) pg/ml] and control [660 (378-1200) pg/ml] groups (p < 0.001). Correlation analysis between the left ventricular mass index and apelin concentrations revealed a significant negative correlation between the two parameters (p < 0.001, r = -0.478). Conclusions: Our study demonstrated decreased apelin levels and increased hsCRP concentrations in patients with severe calcific AS. Our findings may help to clarify the exact pathophysiologic role of apelin in cardiovascular diseases.

Decreased left atrial strain parameters are associated with prolonged total atrial conduction time in lichen planus.

BACKGROUND: Lichen planus (LP) carries the increased risk of cardiovascular events as it is a chronic inflammatory disease. This study aimed at determining the relationship between total atrial conduction time (TACT), P-wave dispersion, and the left atrium (LA) global strain in the patients with LP. METHODS: Forty people as a control group and 40 patients with LP were included in this study. Patient assessed global longitudinal LA strain by two-dimensional speckle-tracking strain echocardiography. RESULTS: The global peak systolic LA myocardium strain during the left ventricular systole (LAGLSRs) and the global peak negative LA myocardial strain rate during the early ventricular diastole (LAGLSRe) values were significantly lower in the patients with LP in proportion to the control group according to the strain measurements (1.7 ± 0.07 vs. 1.9 ± 0.1%, p = 0.001; 1.23 ± 0.04 vs. 1.2 ± 0.08 s-1, p = 0.001), respectively. TACT value was found to be significantly longer (102.6 ± 6.3 ms) in the patients with LP than the control group (96.3 ± 5.3 ms, p = 0.001), considering the terms of the artial conduction features. CONCLUSION: This study demonstrated that the subclinical cardiac involvement in LP can determine the prolonged TACT and the impaired left atrial myocardial deformation values.

Prolonged QRS duration on surface electrocardiogram is associated with left ventricular restrictive filling pattern.

BACKGROUND: Prolonged QRS duration is associated with decreased left ventricular (LV) systolic function. However, the relation between LV restrictive filling pattern (RFP) and QRS duration has not been investigated yet. The purpose of our study was to assess this relationship. METHODS: We analyzed standard 12-lead surface electrocardiogram (ECG) of 155 consecutive patients. Mitral inflow and septal tissue velocities were obtained using the apical 4-chamber view with pulsed Doppler echocardiography. Patients were divided into 2 groups according to measured deceleration time (DT): restrictive (with DT ≤130 ms) or non-restrictive (with DT >130 ms). RESULTS: QRS duration was significantly longer in the restrictive group than in the non-restrictive group (0.101 vs. 0.090 s, p < 0.0001). QRS duration of >0.10 s was highly specific (82.6%), but modestly sensitive (64.7%), for the prediction of LV RFP. Multivariate analyses demonstrated that E/A ratio, peak E, peak A, septal e', and a' velocities were significantly associated with RFP. CONCLUSIONS: Prolonged QRS duration (>0.10 s) obtained from a standard resting 12-lead ECG is associated with LV RFP. However, the relationship of QRS duration with RFP was not independent of echocardiographic parameters.

The role of urotensin II and atherosclerotic risk factors in patients with slow coronary flow.

BACKGROUND: Slow coronary flow (SCF) is an angiographic finding characterized with delayed opacification of epicardial coronary arteries without obstructive coronary disease. Urotensin II (UII) is an important vascular peptide, which has an important role in hypertension, coronary artery disease, and vascular remodeling in addition to potent vasoconstrictor effect. OBJECTIVES: We investigated UII levels, hypertension, and other atherosclerotic risk factors in patients with SCF, a variety of coronary artery disease. METHODS: We enrolled 14 patients with SCF and 29 subjects with normal coronary arteries without SCF. We compared the UII levels and the atherosclerotic risk factors between patients with SCF and control subjects with normal coronary flow. RESULTS: UII concentrations were significantly higher in patients with SCF compared to controls (711.0 ± 19.4 vs. 701.5 ± 27.2 ng/mL, p = 0.006). We detected a positive correlation between SCF and age (r = 0.476, p = 0.001), BMI (r = 0.404, p = .002), UII concentrations (r = 0.422, p = 0.006), and hypertension (r = 0.594, p = 0.001). CONCLUSION: We identified increased UII levels in patients with SCF. We think that UII concentrations may be informative on SCF pathogenesis due to relationship with inflammation, atherosclerosis, and vascular remodeling.

The relationship between epicardial adipose tissue and P wave and QT dispersions.

OBJECTIVE: Epicardial adipose tissue (EAT) secretes various pro-inflammatory and atherogenic mediators that have several endocrine and paracrine effects on heart. This study investigated the influence of EAT on QT and P wave dispersions (QTd, PWd), as simple, non-invasive tools of proarrhythmia on surface ECG. METHODS: This was a cross-sectional study and included 70 patients with normal coronary arteries who underwent 12-derivation electrocardiography, echocardiography and biochemical examinations in order for QTd, PWd, and EAT thickness to be measured. RESULTS: Median EAT thickness was 4.1 mm. Correlation analyses revealed that EAT was significantly associated with age (r=0.412, p<0.001), weight (r=0.262, p=0.028), body mass index (r=0.396, p<0.001), left atrium diameter (r=0.518, p<0.001), fasting plasma glucose (r=0.245, p=0.041), maximum P wave duration (r=0.343, p=0.004), minimum P wave duration (r=0.275, p=0.021) and PWd (r=0.265, p=0.026). No relation was found between study parameters and QTd. However, P wave dispersion was significantly related to EAT thickness (r=0.265, p=0.026), left atrium diameter (r=0.483, p<0.001), and the triglyceride levels (r=0.267, p=0.028). Multiple linear regression analyses revealed left atrial diameter as the only independent predictor of PWd. CONCLUSION: A significant association between EAT and PWd was demonstrated in the study. While EAT is related to both increased PWd and left atrial size, left atrial diameter seems to be more important than EAT for prediction of atrial fibrillation (AF) in patients with normal coronary arteries.

Pleiotropic effects of HDL subfractions and HDL-associated enzymes on protection against coronary artery disease.

OBJECTIVE: High-density lipoprotein cholesterol (HDL-C) levels are inversely related to the risk of coronary artery disease (CAD). Alterations in HDL-C subclass distribution and HDL-associated enzyme activities may be more important than total HDL levels for the progression of CAD. We intended to investigate the relationship of HDL-C subclass distribution and HDL-associated enzyme activities with CAD. METHOD AND RESULTS: Our study included 101 patients with stable coronary artery disease, and 64 healthy subjects. Serum levels of HDL lipoprotein-associated-phospholipase A2 (HDL-LpPLA2), paraoxonase 1 (PON1), and HDL subfraction distribution were measured. We found increased small HDL (sHDL) subfractions in patients with one-vessel disease (P < 0.001). We also found a reverse correlation between total HDL-C levels and affected vessel number (P < 0.05). Plasma HDL-Lp PLA2 enzyme level was higher in each vessel disease category compared to the control group (P < 0.001). However, PON1 enzyme activity in patients with CAD was not statically significant. Plasma sHDL, HDL-Lp PLA2 enzyme and Lp(a) were significantly different between subjects with CAD and control participants. CONCLUSIONS: We demonstrated decreased sHDL particles and a lower cardioprotective HDL-LpPLA, enzyme activity in all patient subgroups compared to controls. Measurement of total HDL-C level only may not be sufficient to predict CAD risk.

Bilirubin Level is Associated with Left Ventricular Hypertrophy Independent of Blood Pressure in Previously Untreated Hypertensive Patients.

BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH), a sign of subclinical cardiovascular disease, is an important predictor of cardiovascular morbidity and mortality. The aim of our study was to determine the association of left ventricular mass (LVM) with possible causative anthropometric and biochemical parameters as well as carotid intima-media thickness (CIMT) and brachial flow-mediated dilation (FMD) as surrogates of atherosclerosis and endothelial dysfunction, respectively, in previously untreated hypertensive patients. SUBJECTS AND METHODS: Our study included 114 consecutive previously untreated hypertensive patients who underwent echocardiography and ultrasonography to evaluate their vascular status and function via brachial artery CIMT and FMD. RESULTS: Among all study parameters, age, systolic blood pressure (BP), diastolic BP, pulse pressure, plasma glucose, uric acid, total bilirubin, direct bilirubin, hemoglobin, and CIMT were positively correlated with the LVM index. Multiple logistic regression analysis revealed that office systolic BP, age, male gender, and total bilirubin were independent predictors of LVH. CONCLUSION: Bilirubin seems to be related to LVM and LVH. The positive association of bilirubin with these parameters is novel and requires further research.

Successful thrombolysis using recombinant tissue plasminogen activator in cases of severe pulmonary embolism with mobile thrombi in the right atrium.

Hereby, we report two cases of acute pulmonary embolism with concomitant right-sided thrombus, which were successfully treated using recombinant tissue plasminogen activator (rtPA). These patients had life-threatening acute right ventricular failure, which dramatically improved within hours following thrombolysis. These cases emphasize the clinical utility of rtPA for the treatment of life-threatening pulmonary embolism.

Retrieval of embolized tip of port catheter from branch of right pulmonary artery using a macro snare catheter.

Rupture of the silicon port catheter is a relatively rare complication. Ruptured part usually embolizes; therefore, removal of foreign body may be difficult. These ports usually migrate to right-sided chambers, main pulmonary arteries, and pulmonary subbranches. Different devices such as snares, basket catheters, and ablation catheters are utilized for retrieval. Hereby, we report successful extraction of an embolized 10-cm tip of a vascular access port using a macro snare catheter.

A rare complication: Undeflatable balloon of the stent.

Percutaneous coronary intervention is an important modality in the treatment of coronary artery disease. These procedures are usually completed successfully, but occasionally serious complications are encountered. In this paper, we present the case of an undeflatable stent balloon, which is an extremely rare complication that has not been described in the literature.