Impact of Iron and Homocysteine Levels on T Peak-to-End Interval and Tp-e/QT Ratio in Elite Athletes.

BACKGROUND: Electrocardiography (ECG) is frequently used in preparticipation evaluation of competitive athletes. Repolarization heterogeneities on ECG is a well-known indicator for malignant ventricular arrhythmias and sudden cardiac death. We aimed to investigate the effect of iron and homocysteine levels on arrhythmogenic indicators, T peak-to-end (Tp-e) interval, and Tp-e/QT ratio in elite athletes. METHODS: A total of 72 players (48 football and 24 basketball) with a mean age of 25.4 ± 5.0 years were included to the analysis. Blood biochemistry, homocysteine level, and iron parameters (transferrin saturation and serum iron) were obtained by standard methods. Duration of QRS, QT interval, and Tp-e interval were measured manually on the precordial leads and Tp-e/QT ratio was calculated. RESULTS: Baseline demographic and clinical characteristics of the study population were compared in two groups according to the median value of Tp-e/QT = 0.219. Both iron and transferrin saturations were higher in the above median group (P = 0.001 and P = 0.002, respectively), however, homocysteine levels were not statistically different among two groups (P = 0.405). In correlation analysis, both serum iron and transferrin saturation were significantly correlated with Tp-e interval (r = 0.368; P = 0.001 and r = 0.394; P = 0.00, respectively) and Tp-e/QT ratio (r = 0.357; P = 0.002 and r = 0.372; P = 0.001, respectively). Multiple stepwise regression analysis revealed that transferrin saturation was an independent predictor of Tp-e interval and Tp-e/QT ratio (ß = 0.325; P = 0.002 and ß = 0.372; P = 0.001, respectively). CONCLUSION: This study showed an independent relationship between iron status and Tp-e interval and Tp-e/QT ratios of elite sport players which were also not correlated with serum homocysteine levels.

Evaluation of infections associated with implantable cardiac electronic devices: 10 years of experience in a single center.

PURPOSE: Cardiac implantable electronic device (CIED) is used increasingly in recent years. In this study, it is aimed to evaluate the frequency of CIED-associated infections in the cardiology clinic of our hospital in the last 10 years, the causative microorganisms by determining their risk factors and clinical characteristics. MATERIALS AND METHODS: 225 patients who underwent CIED implantation in our hospital's cardiology clinic between March 2009 and December 2019 were retrospectively identified. The patients were grouped as with and without CIED-associated infection. RESULTS: In a period of approximately 10 years, the rate of CIED infection was determined as 4.8%. 9 of the patients (81.8%) had CIED infection after the first implantation, and 2 of the patients (18.2%) after replacement. When the groups with and without CIED infection were compared; there was no significant difference in the group with CIED infection compared to the control group in terms of age, gender, type of the device inserted and the way of placing the device (implantation/replacement). Comparing risk factors between CIED infection and control group, there is no significant difference in terms of diabetes mellitus (DM), congestive heart failure, renal failure, hypertension, dyslipidemia, malignancy, immunosuppression. The use of anticoagulation was found statistically significant. CONCLUSIONS: CIED infections occur clinically with increased morbidity and mortality due to factors related to the patient and/or the type of device implanted. Knowing the patient's comorbid conditions well and taking precautions before CIED implantation can contribute to the reduction of the CIED infections.

The effect of different atrioventricular delays on left atrium and left atrial appendage function in patients with DDD pacemaker.

BACKGROUND: Although it has been known that optimization of atrioventricular delay (AVD) has favorable effect on the left ventricular functions in patients with DDD pacemaker, the effect of different AVDs on left atrium (LA) and left atrial appendage (LAA) functions has not been exactly evaluated. The aim of the present study was to assess the effect of different AVDs on LA and LAA functions in DDD pacemaker implanted patients with atrioventricular block. METHODS: Forty-eight patients with DDD pacemaker were enrolled into the study. Patients were divided into two groups according to the echocardiographic diastolic function: Group I (normal diastolic function) and Group II (diastolic dysfunction). LAA emptying velocity on pulsed wave Doppler and LAA late systolic wave velocity by using tissue Doppler were recorded. Patients were paced for five successive continuous pacing periods of 10 minutes duration using five selective AVDs (80-250 ms). RESULTS: Significant effect on LA and LAA functions has not been observed by the setting of AVD in Group I. However, when the AVD was gradually shortened form 150 ms to 80 ms, LA and LAA functions gradually decreased in Group II patients. When AVD increased to 200 ms, LA and LAA functions were improved. Further increase in AVD resulted in decreased LA and LAA functions. CONCLUSION: Setting of AVD has not significant effect on the LA and LAA functions in patients with normal diastolic function, but moderate prolongation of AVD in physiological limits improved LA and LAA functions in DDD pacemaker implanted patients with diastolic dysfunction.

[Usefulness of high-sensitivity CRP increases during circadian rhythm for prediction of long-term cardiovascular events in patients with stable coronary artery disease]. / Kararli koroner arter hastalarinda günlük döngü içinde artis gösteren yüksek duyarlikli CRP düzeyinin uzun dönem kardiyovasküler olaylari öngörmede kullanilabilirligi.

OBJECTIVES: We investigated the value of circadian variations in high-sensitivity C-reactive protein (hs-CRP) levels in prediction of long-term cardiovascular events (CVE) in patients with stable coronary artery disease (CAD). STUDY DESIGN: The study included 94 patients (70 men, 24 women; mean age 58 ± 9 years) with stable CAD. High-sensitivity CRP levels were measured at six-hour intervals, namely, morning (06:00), midday (12:00), evening (18:00), and midnight (24:00). Absolute change in hs-CRP (absolute ΔCRP) was calculated by subtracting the midday hs-CRP level from that of the morning. Relative change in hs-CRP (relative ΔCRP) was calculated by dividing absolute ΔCRP by the midday hs-CRP level. The patients were followed-up for a mean of 40.2 ± 8.0 months for monitoring of CVE. RESULTS: During the follow-up period, CVE occurred in 24 patients (25.5%). Patients who developed CVE exhibited significantly higher serum creatinine, B-type natriuretic peptide, morning, evening, and midnight hs-CRP levels, absolute and relative ΔCRP, and left atrial end-diastolic diameter compared to patients without CVE (p<0.05). In logistic regression analysis, only left atrial end-diastolic diameter and absolute ΔCRP were independent predictors of CVE (OR=1.11, 95% CI 1.003-1.236, p=0.044 and OR=1.58, 95% CI 1.195-2.090, p=0.001, respectively). Every 1 mg/l increase in absolute ΔCRP represented a 58.1% increase in CVE risk. In receiver operating characteristics curve analysis, the cut-off value of 2 mg/l for absolute ΔCRP predicted CVE with 89.5% sensitivity and 84.2% specificity. CONCLUSION: Our findings suggest that absolute circadian increases in hs-CRP levels may be helpful in predicting long-term CVEs in patients with stable CAD.

Short-term effect of levosimendan on free light chain kappa and lambda levels in patients with decompensated chronic heart failure.

To investigate the effects of levosimendan, a positive inotropic agent, on the new heart failure markers immunoglobulin free light chains kappa and lambda (FLC-kappa and FLC-lambda) in decompensated chronic heart failure (HF), 59 patients with New York Heart Association (NYHA) class III-IV HF were enrolled. Patients were randomized into levosimendan (n = 31) and standard HF treatment (n = 29) groups. Serum FLC-kappa and FLC-lambda, brain natriuretic peptide (BNP), and ejection fraction (EF) were measured before treatment and on the 5th day of treatment initiation. Forty-two percent of subjects were females (n = 25) and overall mean age was 64.1 +/- 10.7 years. FLC-kappa (P < 0.05) and FLC-lambda (P < 0.05) were significantly decreased in the levosimendan group compared to baseline, but no difference in either marker in the standard treatment group was observed. Pre- and post-treatment FLC-kappa/FLC-lambda ratios in both groups were similar, whereas FLC-kappa and FLC-lambda levels and the FLC-kappa/FLC-lambda ratio showed no significant correlation with NYHA class, brain natriuretic peptide (BNP) and ejection fraction (EF) levels; and BNP and EF changes after the treatment. Symptomatic improvement in the levosimendan group according to the NYHA class was significantly better than in the standard treatment group (P = 0.044). While 55.2% of patients in the levosimendan group showed a 1-degree shift to lower NYHA classes, 10.3% showed a 2-degree decrease. In conclusion, levosimendan caused short-term hemodynamic and symptomatic improvements, with a more pronounced decrease in FLC levels in patients with advanced decompensated HF.

Robotic Septal Myectomy and Mitral Valve Repair for Idiopathic Hypertrophic Subaortic Stenosis With Systolic Anterior Motion.

Combined therapeutic approach with performing mitral valve repair may be necessitated for the treatment of idiopathic hypertrophic subaortic stenosis (IHSS) with systolic anterior motion. This report includes operative technique for combined robotic septal myectomy and mitral valve repair. A 45-year-old man with IHSS was admitted to our center for surgical intervention. The transthoracic echocardiography showed typical asymmetric ventricular hypertrophy. Left ventricle posterior wall thickness was 11 mm, and interventricular septum thickness was 21 mm. Mitral valve leaflets were found to be elongated. Mild-to-severe mitral regurgitation was detected with eccentric mitral jet. Aortic peak gradient was 128 mm Hg. Robotic mitral repair and septal myectomy through left atrial exposure was performed. The anterior leaflet was detached, and the septal muscle in a mass of 1 × 0.7 × 0.5 cm was resected. Next, the anterior leaflet was reattached with continuous suture. The plication of the posterior leaflet with transverse incision was performed to diminish the length of posterior leaflet. After the magic suture for posteromedial commissure was performed, a 34 Medtronic Future ring was implanted for mitral annuloplasty. Postoperative course was uneventful. The patient was discharged on the sixth postoperative day. Combined robotic septal myectomy and mitral valve repair for IHSS with systolic anterior motion may be feasible.

Changes in BNP, hs-CRP and TIMI risk index with addition of tirofiban during primary percutaneous coronary intervention for acute STEMI: a prospective observational cohort study.

OBJECTIVE: This study aimed to investigate the relationship of tirofiban, added to the treatment of acute ST-elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (PCI), with changes in the TIMI risk index (TRI) of TIMI flow, B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hs-CRP) levels. METHODS: This single-center, prospective observational cohort study included 102 consecutive patients who were admitted with the diagnosis of acute STEMI (70 male; 54.9±10.4 years). Primary PCI was applied to all cases with STEMI, who applied to our hospital in the first 6 hours due to chest pain complaints. Tirofiban was administered to one group (n=55) (male: 36; 54.1±11.3 years), while the other group was not given tirofiban (n=47) (male: 34; 55.9±9.1 years). The primary end-point was TIMI flow 2 or 3 for reperfusion after primary PCI. Chi-square test, paired t-test or Wilcoxon signed rank test, Spearman correlation analysis and Kaplan-Meier survival analysis were used for statistical analysis where appropriate. RESULTS: BNP level remained the same in the tirofiban group, whereas a significant increase was observed in the group that was not treated with tirofiban (105.9±126.8 versus 261.3±202.3 pg/ml p<0.001). The hs-CRP level tended to rise significantly in both groups despite the treatment (tirofiban group - from 0.67±0.66 to 0.90±0.44 mg/L, p=0.015, non tirofiban group - from 0.51±0.43 to 1.08±0.74 mg/L, p<0.001). BNP and hs-CRP values remained the same in cases with TIMI 2 flow in the tirofiban group, whereas a significant increase was detected in the post-treatment BNP (before 97.8±122.3 after 281.6±217.3 pg/ml, p=0.011) and hs-CRP (before 0.65±0.69; after 1.33±0.80 mg/L, p=0.028) values in the group not treated with tirofiban. In patients with TIMI 3 flow, BNP (tirofiban group before 146.5±114.2; after 184.4±139.4 pg/ml, p=0.011, non tirofiban group before 172.1±297.9; after 295.9±384.9 pg/ml, p<0.001) and hs-CRP levels (tirofiban group before 0.66±0.58; after 0.92±0.65 mg/L, p=0.011, non tirofiban group before 0.81±0.74; after 1.45±1.23 mg/L, p<0.001) were found to be similarly reduced in both treatment groups p<0.05. Three patients with minor hemorrhage did not need blood transfusion. CONCLUSION: It was concluded at the end of them PCI application in STEMI that the addition of tirofiban treatment in patients with ≥TIMI 2 flow and anterior location MI could decrease the expected rise in BNP and CRP values.

The effect of streptokinase therapy in STEMI and conventional therapy in NSTEMI patients on TIMI risk index, B-type natriuretic peptide and high-sensitive C-reactive protein.

OBJECTIVE: In this study, it was aimed to investigate the effect of streptokinase therapy in ST elevation myocardial infarction (STEMI) and conventional therapy in non-ST elevation myocardial infarction (NSTEMI) patients on the thrombolysis in myocardial infarction (TIMI) risk index (TRI), B-type natriuretic peptide (BNP), and high-sensitive C-reactive protein (hs-CRP) levels. METHODS: Eighty-six STEMI (male/female ratio: 65/21, mean age 57.52±9.87 years) and eighty NSTEMI patients (male/female ratio: 50/30, mean age 57.6±1.7 years) were included in this prospective observational study. Hs-CRP and BNP were measured and TIMI risk index was calculated in all patients. Coronary angiography was performed in all patients for principally determining TIMI flow rate. Chi-square test, paired t-test or Wilcoxon signed rank test, ANOVA and Spearman correlation analysis were used for statistical analysis where appropriate. RESULTS: STEMI patients had higher systolic blood pressure, heart rate, BNP and hs-CRP values than NSTEMI patients at admission (p=0.04, p=0.01, p=0.001 and p=0.01, respectively). Thrombolytic therapy in STEMI patients resulted in statistically significant higher levels of BNP, hs-CRP and TRI values compared to baseline levels (p=0.001, p=0.001 and p=0.042, respectively). For NSTEMI patients conventional therapy yielded statistically significant decrease in systolic blood pressure levels and increase in TRI (p=0.001 and p=0.047, respectively). We found significantly lower BNP, hs-CRP in patients with higher TIMI flow rate (p=0.001 and p=0.001 respectively). CONCLUSION: Thrombolytic therapy with streptokinase failed to decrease BNP, hs-CRP and TRI values in STEMI patients. Conventional therapy in NSTEMI patients also resulted in higher TRI values than baseline values. We reached TIMI 3 flow in only 10.5% of the study patients, which may be responsible for our findings.

Clinical utility of serum cystatin C in predicting coronary artery disease.

BACKGROUND: There is limited data regarding the clinical utility of cystatin C in patients with stable coronary artery disease (CAD). The aim of this study was to determine the predictive value of cystatin C for the presence and severity of CAD and the association between this protein and other biochemical risk factors for atherosclerosis in patients with suspected CAD. METHODS: Ninety-four patients with CAD, and 92 patients without CAD but with cardiovascular risk factors, were included in this study. Echocardiography and other pertinent laboratory examinations were performed. Subjects were divided into four groups according to their cystatin C quartile. Cystatin C groups were analyzed for the association with CAD characteristics. RESULTS: The number of patients with CAD increased as the quartile of cystatin C increased, and there was a remarkable difference between quartiles (p < 0.001). Logistic regression analysis revealed independent predictors of incident CAD as cystatin C, hs-CRP, eGFR, HDL cholesterol and SBP (p = 0.005, p = 0.027, p = 0.017, p = 0.014 and p = 0.001, respectively). Moreover, cystatin C concentration was significantly correlated with CAD severity score (b = 0.258, p < 0.01). A cut-off value of 0.82 mg/L for cystatin C predicted incident CAD with a sensitivity and specificity of 75.5% and 75.0% respectively. Cystatin C concentration also correlated well with the atherosclerotic biochemical risk factors like homocysteine, creatinine and hs-CRP. CONCLUSIONS: Cystatin C could be a useful laboratory tool in predicting the presence and severity of CAD in daily practice. It also correlates significantly with biochemical risk factors for CAD, namely homocysteine, low HDL and CRP.

Variation in high-sensitivity C-reactive protein levels over 24 hours in patients with stable coronary artery disease.

Limited, controversial data exist regarding changes in high-sensitivity C-reactive protein (hs-CRP) levels over short times and the importance of detecting these changes in patients who have coronary artery disease (CAD). We investigated the variation of hs-CRP levels and their association with the severity of CAD in patients with stable CAD.We measured morning, midday, evening, and midnight hs-CRP levels in 124 patients (94 with CAD, 30 with normal coronary arteries), who were evaluated via coronary angiography and Gensini scoring. Patients were divided into 3 groups (normal coronary arteries, mild CAD, or severe CAD) according to Gensini score.Temporal hs-CRP levels varied significantly--the highest mean concentrations were found in the morning, and the lowest concentrations at midday (P <0.001). All temporal hs-CRP measurements and the absolute increase in hs-CRP levels were significantly higher in patients with severe CAD (both P <0.001). The most significant predictors of CAD severity were age (P=0.005), midday hs-CRP level (P <0.001), and brain natriuretic peptide level (P=0.045). Receiver operating characteristic curve analysis showed that cutoff values of hs-CRP taken at different times predicted severe CAD with similar sensitivity and specificity. Different cutoff values for temporal hs-CRP levels correlated with the severity of CAD. Serum levels of hs-CRP varied over 24 hours, whether patients had CAD or normal coronary arteries.

Usefulness of endovascular stent-graft for combination with a strict aort coarctation and patent ductus arteriosus for an adult patient: a case report.

We reported a 21-year-old patient with strict descending aorta coarctation and small post-ductal patent ductus arteriosus, complicated with abortion and hypertension. The patient was successfully treated by endovascular stent-graft with a single cardiac catheterization. Endovascular stent-graft is an easy, safe, and reliable intervention for the treatment of strict descending aorta coarctation and small post-ductal patent ductus arteriosus.

Embolization of pacing electrode fragment into the superolateral vein in the spinal canal causing root compression.

Lead extraction may be complicated by lead fracture and embolization of the lead fragments into the pulmonary circulation or other vasculature causing various signs and symptoms. We present a very unusual case demonstrating embolization of a pacemaker electrode fragment into the superolateral vein in the spinal canal causing root compression. The electrode fragment was removed by spinal surgery, and the patient's symptoms gradually resolved.

Angioplasty induced myocardial ischaemia prolongs the signal-averaged P-wave duration in single vessel coronary artery disease.

Aims The P-wave duration (PWD) has been shown to prolong in conditions associated with elevated left ventricular end-diastolic and left atrial pressures, which also increase during transient coronary artery occlusions such as angioplasty. The aim of this study was to investigate the effects of angioplasty-induced myocardial ischaemia on signal averaged PWD in patients undergoing coronary angioplasty. Methods Eighty-four consecutive adult patients with single-vessel coronary artery disease undergoing elective coronary angioplasty were included. Duration of the P wave before and during coronary angioplasty were evaluated using signal averaged P-wave analysis. Patients were classified in groups according to the artery occluded, as left anterior descending (LAD) Group, right coronary artery (RCA) Group or Others Group (which included obtuse marginal, circumflex or diagonal). Results Patients included in the LAD, RCA and Others groups were similar with respect to clinical characteristics. The mean PWD at baseline was similar in all lesions (P>0.05), whereas mean PWD at inflation was significantly longer in LAD Group compared with RCA (126.1 +/- 9.5 ms vs 118.7 +/- 10.4 ms, P=0.007) and Others (126.1 +/- 9.5 ms vs 116.3 +/- 8.6 ms, P<0.001). The PWD during balloon inflation was significantly prolonged in all groups compared with baseline levels (LAD Group 126.1 +/- 9.6 ms vs 109.7 +/- 8.0 ms; RCA Group 118.7 +/- 10.4 ms vs 108.3 +/- 8.4 ms and Others Group 116.3 +/- 8.6 ms vs 109.7 +/- 6.0 ms, all P values <0.001). Conclusion Signal-averaged PWD significantly increases during single-vessel coronary angioplasty. This increase is more pronounced for LAD lesions. However, the clinical implications of P-wave prolongation during balloon angioplasty and the value of PWD as a measure of ischaemia remains to be clarified.