Percutaneous Coronary Intervention for Chronic Total Occlusion versus Percutaneous Coronary Intervention for Non-Complex Coronary Lesions: Is There a Different Impact on Thyroid Function?

OBJECTIVE: This study assessed whether high levels of iodide administered during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) differentially influenced thyroid function compared to PCI for non-complex coronary lesions. SUBJECTS AND METHODS: A total of 615 patients were enrolled in the study; 205 underwent elective PCI for CTO lesions (Group I) and 410 underwent elective PCI for non-complex lesions including non-CTO, non-bifurcation, non-calcified, and non-tortuous lesions (Group II). Patients were monitored for development of incidental thyroid dysfunction between 1 and 6 months after PCI. RESULTS: The patients in Group I were administered a median of 255 mL of contrast medium during PCI for CTO; a median of 80 mL was administered to the patients in Group II during non-complex PCI (p =0.001). Ten (5.4%) of the 186 euthyroid patients in Group I and 19 (5%) of the 379 eu-thyroid patients in Group II developed subclinical hyper-thyroidism (p = 0.854). However, 7 (50%) of the 14 subclinical hyperthyroid patients in Group I and only 3 (12%) of the 25 subclinical hyperthyroid patients in Group II developed overt hyperthyroidism (p = 0.019). CONCLUSION: In euthyroid patients, PCI for coronary CTO lesions did not increase the risk for subclinical hyperthyroidism when compared to PCI for non-complex coronary lesions. However, in patients with subclinical hyperthyroidism at baseline, PCI for coronary CTO lesions significantly increased the development of overt hyperthyroidism when compared to PCI for non-complex coronary lesions.

Pulse wave velocity and myocardial performance index in premature ovarian insufficiency.

OBJECTIVE: Epidemiological studies suggest that women with loss of ovarian function at early ages may be especially burdened by cardiovascular disease (CVD). In this study, we aimed to evaluate pulse wave velocity (PWV) and myocardial performance index (MPI) in patients with premature ovarian insufficiency (POI). DESIGN: We enrolled 51 female patients (mean age 38.9 ± 6.7 years) with POI and 49 healthy subjects (mean age 36.8 ± 5.2 years). All participants underwent a detailed echocardiographic examination and PWV measurement, which is basically the velocity of pulse wave travelling from carotid to femoral artery. RESULTS: Both groups were similar with regard to age, body mass index (BMI) and left ventricular ejection fraction. When diastolic functions were assessed, patients with POI had higher mean E/E'ratio (9.3 ± 1.9 vs. 7.6 ± 1.6, p < 0.001). POI patients have impaired MPI (0.9 ± 0.5 vs. 0.5 ± 0.2, p < 0.001) comparing to healthy controls but PWV measurements did not differ between two groups (5.7 ± 0.8 vs. 5.6 ± 0.6 m/s, p = 0.48). CONCLUSIONS: This study showed POI patients might have impaired global left ventricular functions comparing to age matched healthy controls and this might reflect the effects of premature lack of estrogen (E) on women's cardiovascular (CV) system.

Altered Plasma MicroRNA Expression in Patients with Mitral Chordae Tendineae Rupture.

BACKGROUND: Mitral chordae tendineae rupture (MCTR) is a progressive disorder which leads to severe mitral regurgitation. Despite its importance, the precise pathogenetic mechanism of MCTR remains unclear. The study aim was to investigate the expression profile of circulating microRNAs (miRNAs) as being potentially involved in the development of MCTR. METHODS: Twenty-one patients with 'primary' MCTR, and 30 age- and gender-matched controls, were enrolled in the study. Comparisons were made between the expression levels of circulating miRNAs in MCTR patients and controls. Four target gene databases were used to predict target genes and pathways of differentially expressed miRNAs. RESULTS: Compared to controls, the expression of 22 miRNAs (hsa-miR-106b-5p, hsa-miR-126-3p, hsa-miR-150-5p, hsa-miR-17-5p, hsa-miR-195-5p, hsa-miR-19a-3p, hsa-miR-19b-3p, hsa-miR-20a-5p, hsa-miR-21-5p, hsa-miR-222-3p, hsa-miR-223-3p, hsa-miR-23a-3p, hsa-miR-25-3p, hsa-miR-92a-3p, hsa-miR-93-5p, hsa-miR-26b-5p, hsa-miR-30e-5p, hsa-miR-373-3p, hsa-miR-15b-5p, hsa-miR-16-5p, hsa-miR-191-5p, hsa-miR-26a-5p) were significantly down-regulated in the MCTR group. Bioinformatic analysis indicated that the following potential miRNA targets and pathways are commonly related to the development of MCTR: MMPs, TIMP-2,TGFBR2, VEGFA, PIK3R2, NRAS, PPP3CA, PPP3R1, PTGS 2 were predicted as putative targets of 13 of these miRNAs. CONCLUSIONS: The present study is the first to describe altered miRNA expression in patients with MCTR. Bioinformatic analysis has revealed that target genes involved in MCTR development were regulated by miRNAs.

Volume depletion provided by blood donation alters twist mechanics of the heart: Preload dependency of left ventricular torsion.

OBJECTIVES: The crucial role of twisting motion on both left ventricular (LV) contraction and relaxation has been clearly identified. However, the reports studying the association between LV torsion and loading conditions have revealed conflicting outcomes. Previously normal saline infusion was shown to increase LV rotation. Our aim was to test this phenomenon after volume depletion in healthy volunteer blood donors. DESIGN: A total of 26 healthy male volunteers were included in the study. LV end-diastolic and end-systolic diameter, LV ejection fraction, LV diastolic parameters, LV apical and basal rotation and peak systolic LV torsion were measured by speckle-tracking echocardiography before and after 450 mL blood donation. RESULTS: Blood donation led to a significant decrease in end-diastolic LV internal diameter (48.7 ± 0.4 versus 46.4 ± 0.4 mm; p < 0.001) and cardiac output (6.2 ± 1.0 versus 5.1 ± 0.7 L/min; p < 0.001). There was a significant decrease in the magnitude of peak systolic apical rotation (4.4 ± 1.9° versus 2.9 ± 1.5°; p < 0.001) but no change in basal rotation (2.6 ± 1.4° versus 2.7 ± 1.6°; p = 0.81). Peak systolic LV Torsion decreased after blood donation (6.9 ± 1.9° versus 5.7 ± 2.1°; p = 0.028). CONCLUSIONS: LV apical rotation and peak systolic LV torsion seem to be preload dependent. Preload reduction provided by 450-mL blood donation decreased LV torsion in healthy male volunteers. Volume dynamics should be taken into account in the evaluation of LV torsion.

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience.

BACKGROUND: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. PATIENTS AND METHODS: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. RESULTS: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). CONCLUSIONS: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

Echocardiographic Evaluation of Biventricular Function in Patients with Euthyroid Hashimoto's Thyroiditis.

OBJECTIVE: The aim of this study was to evaluate the left (LV) and right (RV) ventricular function in euthyroid Hashimoto's thyroiditis (eHT) patients. SUBJECTS AND METHODS: Forty-five patients diagnosed with eHT and 45 age- and gender-matched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities (E, A, E', A'), isovolumic relaxation (IVRT) and contraction (IVCT) times, ejection time (ET), deceleration time (DT), Tei index, pulmonary acceleration time (PAcT) and tricuspid annular plane systolic excursion (TAPSE) of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signed-rank test. RESULTS: Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index (0.6 ± 0.2 vs. 0.4 ± 0.1, p < 0.001), higher DT (p < 0.001) and IVRT (p < 0.001) values, and higher E/E' ratios (p = 0.04). In contrast, the peak E wave velocity (p = 0.02), E/A ratio (p = 0.01) and ET (p = 0.02) were significantly lower in the eHT group than amongst the controls. The RV, Tei index (0.40 ± 0.11 vs. 0.28 ± 0.07, p < 0.001), TAPSE (2.0 ± 0.3 vs. 2.2 ± 0.2 mm, p < 0.001), PAcT (124.3 ± 22.6 vs. 149.4 ± 18.3 ms, p < 0.001), A' (p = 0.007) and IVCT (p = 0.001) were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio (p = 0.01), E' (p = 0.03) and E'/A' ratio (p = 0.001) were significantly lower in the eHT patients than the control group. CONCLUSIONS: This study demonstrated that both RV and LV functions were impaired in patients with eHT.

Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options.

OBJECTIVES: We aimed to present our experience regarding the unusual vascular complications and specific treatment strategies in patients who underwent transradial coronary procedure (TRC). BACKGROUND: Transradial access provides lower vascular access site complication rates compared with transfemoral access. However, there is lack of data obtained from large study populations concerning the incidence and treatment strategies of hemorrhagic and vascular complications following a TRC in the literature. METHODS: 10,324 patients (2,652 patients with percutaneous coronary intervention and 7,672 patients with a diagnostic transradial coronary angiography) who underwent a TRC from February 2010 to December 2014 were reviewed to identify cases of large hematoma, perforation, arteriovenous fistula, and pseudoaneurysm. RESULTS: The observed incidence was 0.44% (45 patients) for all unusual vascular and hemorrhagic complications. Of these 45 patients; 32 patients (0.31%) presented with large hematoma (≥6 cm), 8 patients (0.08%) presented with perforation, 4 patients (0.04%) presented with arteriovenous fistula (AVF), and only 1 case (0.009%) presented with radial artery pseudoaneurysm. Forty-one of forty-five patients were managed with mechanical compression. Surgery was performed in only 3 cases; a patient with a brachial artery perforation leading to compartment syndrome, a patient with AVF resulting in limb ischemia, and a patient with radial artery pseudoaneurysm. A right internal mammarian artery perforation resulting in huge breast hematoma was treated via endovascular graft stent implantation. CONCLUSIONS: Hemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction.

Diabetic patients have increased perioperative cardiac risk in heart-type fatty acid-binding protein-based assessment.

OBJECTIVE: To test the potential role of heart-type fatty acid-binding protein (H-FABP) in detecting increased perioperative cardiac risk in comparison with cardiac troponin I (cTnI) in the early postoperative period. SUBJECTS AND METHODS: Sixty-seven patients who had clinical risk factors and underwent elective intermediate - or high-risk noncardiac surgery were included in this study. Serum specimens were analyzed for H-FABP and cTnI levels before and at 8 h after surgery. None of the patients had chest pain; 27 had a history of ischemic heart disease, 3 of heart failure, 5 of cerebrovascular diseases, 40 of diabetes and 46 of hypertension. RESULTS: The mean duration of the operations was 2.33 ± 1.27 h (range 1-6). In the postoperative period, 27 (40.3%) patients had increased H-FABP levels (≥7.5 ng/ml); the median preoperative serum H-FABP level was 0.13 ng/ml (<0.1-5.9) and the median postoperative H-FABP level was 6.86 ng/ml (<0.1-13.7). Only 1 (1.5%) patient had cTnI >0.1 µg/l during the postoperative period. Correlation analysis revealed that the presence of diabetes was associated with an increased H-FABP level (r = 0.30, p = 0.01). Of the 27 patients with H-FABP ≥7.5 ng/ml, 21 (87%) had diabetes. There was no significant correlation with other clinical risk factors, type or duration of surgery. CONCLUSION: The H-FABP levels significantly increased in the postoperative period. Most patients with increased postoperative H-FABP levels were diabetic. High H-FABP levels could alert clinicians to increased perioperative cardiovascular risk and could prevent underdiagnosis, especially in diabetic patients.

High-density lipoprotein subfractions and influence of endothelial lipase in a healthy Turkish population: a study in a land of low high-density lipoprotein cholesterol.

PURPOSE: Low concentration of high-density lipoprotein (HDL) is prevalent in Turkey. Endothelial lipase (EL) regulates lipoprotein metabolism. Small, lipid-poor HDL particles represent more-efficient cholesterol acceptors than their large, lipid-rich counterparts. The aim of this study was to investigate HDL subfractions and the effect of EL on HDL concentrations in healthy Turkish population. METHODS: 102 healthy subjects were included in the study (mean age 33.6 ± 10.3 years, 42 female). HDL subfractions were assayed by single precipitation method and EL concentrations were measured by competitive enzyme immunoassay. RESULTS: Mean HDL concentrations were 1.45 ± 0.37 mmol/L in women, 1.10 ± 0.30 mmol/L in men. Small HDL subfraction levels did not differ statistically between < 1 mmol/L and ≥ 1.6 mmol/L total HDL groups. Small HDL was not correlated with EL, low density lipoprotein cholesterol (LDL), triglyceride (TG) and age but positively correlated with total cholesterol and HDL (r = 0.2, p = 0.017; r = 0.2, p = 0.028, respectively). Large HDL was not correlated with age, EL and total cholesterol, and negatively correlated with HDL, LDL, TG (r = - 0.7, p < 0.001; r = - 0.2, p = 0.045; r = - 0.3, p < 0.001, respectively). If subjects were divided into two groups as HDL< 1 mmol/L and HDL > 1.6 mmol/L, mean EL concentrations were 475.83 ± 521.77 nmol/L and 529.71 ± 276.92 nmol/L, respectively (p = 0.086). CONCLUSION: There were no differences between small HDL concentrations in the HDL low and high groups. Our data did not support EL to be the reason for low HDL in a healthy Turkish population. Our results in a healthy population may serve as a reference for clinical studies on HDL subfractions.

Effect of internal carotid artery stenting on superior thyroid artery Doppler flow.

OBJECTIVES: Patients with carotid disease are frequently referred for carotid artery stenting based on the results of carotid duplex studies. During carotid artery stenting, the stent is usually extended into the common carotid artery, thereby crossing the external carotid artery. Previous studies have shown conflicting results regarding internal carotid stenting and external carotid artery flow velocities, but the effect of stenting on ipsilateral superior thyroid artery velocities has not been defined. This study examined the effect of internal carotid angioplasty and stenting on the ipsilateral superior thyroid artery Doppler-derived flow parameters. METHODS: We prospectively studied preinterventional and postinterventional duplex scans obtained from 41 patients (mean age ± SD, 64 ± 10 years) who underwent carotid artery stenting. The Doppler-defined preprocedural peak systolic velocity (PSV) end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) in the ipsilateral external carotid and superior thyroid arteries were compared with postprocedural values. RESULTS: Among patients with stenting, the preprocedural PSV, EDV, RI, and PI in the ipsilateral superior thyroid artery were 30 ± 11 cm/s, 13 ± 6 cm/s, 0.62 ± 0.11, and 1.04 ± 0.28,respectively; after stenting, they were 36 ± 8 cm/s, 14 ± 9 cm/s, 0.71 ± 0.07, and 1.11 ± 0.19. The preprocedural PSV, EDV, RI, and PI in the ipsilateral external carotid artery were 79 ± 24 cm/s, 17 ± 7 cm/s, 0.77 ± 0.26, and 1.27 ± 0.22; after stenting, they were 94 ± 31 cm/s, 20 ± 6 cm/s, 0.80 ± 0.4, and 1.25 ± 0.31. Despite a slight increase in superior thyroid and external carotid artery flow, there was no statistically significant change from before to after stenting. CONCLUSIONS: This study showed no differences in blood velocity profiles in the ipsilateral superior thyroid and external carotid arteries after stenting.

An invasive but simple and accurate method for ascending aorta-femoral artery pulse wave velocity measurement.

INTRODUCTION: Pulse wave velocity (PWV) is an emerging predictor in the assessment of cardiovascular risk in diseased and healthy populations. We suggest a novel method for the accurate measurement of PWV. METHOD: PWV is calculated from pulse transit time using two separate pulse recordings over a known distance. 8F sheaths were placed in the right femoral arteries and routine coronary angiographies were performed with 5F diagnostic catheters. Ascending aorta pressures were measured with right diagnostic catheter tip in the ascending aorta and synchronous femoral artery pressures were measured with the sheath in the femoral artery. The distance between the two pressure sites was calculated as follows: total length of the right diagnostic catheter-length of the catheter outside the sheath-Sheath length. RESULTS: We evaluated the PWV measured using the catheter method in 24 subjects. PWV correlated positively and independently with age (p = 0.004), coronary artery disease (p = 0.04), ascending aorta systolic pressure (p = 0.006), femoral artery systolic pressure (p = 0.008), ascending aorta pulse pressure (p = 0.003) and femoral artery pulse pressure (p = 0.04). In coronary artery disease patients, the mean PWV value was significantly higher than in patients with normal coronary arteries (12.61 ± 6.31 m/s vs 7.58 ± 2.26 m/s p = 0.04). CONCLUSION: We describe a novel and accurate but invasive method for measurement of PWV. Our results may serve as a reference for non-invasive assessment of aorta-femoral artery PWV.

Bizarre electrocardiographic changes during occlusion of a congenital coronary arteriovenous fistula.

A 38-year-old man who had a history of percutaneous coronary artery coil occlusion was admitted to our hospital with chest pain and shortness of breath. His complaint was chest pain, which is typical. ST depressions were observed during the treadmill exercise stress test. Coronary angiography demonstrated the persistence of a coronary arteriovenous fistula and coils in the fistula. Primarily, additional coil placement inside the arteriovenous fistula was decided as the mode of treatment. The coil was first placed inside the arteriovenous fistula and then an attempt was made to detach it. However, it was unsuccessful after four trials and electrical detachment of more than 3 minutes. Finally, a 2.5 × 18-millimetre graft stent was deployed at 20 atmospheric pressure. Electrocardiographic recordings showed bizarre ST segment changes during the electrical detachment of the coil. In this report, we discuss the concealed bizarre electrocardiographic changes that were seen during coronary arteriovenous fistula occlusion.

Relationship between HbA1c levels and coronary artery severity in nondiabetic acute coronary syndrome patients.

OBJECTIVES: In this study, we aimed to investigate the relationship between HbA1c levels and the severity of coronary artery stenosis in patients with acute coronary syndrome (ACS) without diabetes mellitus. STUDY DESIGN: In this study, we included 65 patients (11 females, mean age: 57±11.42 years; 54 males, mean age: 54.56±8.51 years) who were diagnosed as acute myocardial infarction without diabetes mellitus. During hospitalization, fasting blood glucose, postprandial blood glucose and HbA1C were measured in each patient. Gensini score was used to assess the severity of coronary artery disease. RESULTS: Twenty patients (30.8%) had hypertension, 15 (23.1%) had impaired fasting glucose, 10 (15.3%) had combined impaired fasting and postprandial glucose, 28 had a low HDL cholesterol (45%), and 30 (46%) had abdominal obesity. Coronary angiography revealed one-vessel disease in 13 patients (20%), and two- and three-vessel disease in 52 patients (80%). There were no significant differences in terms of high-sensitive C-reactive protein (hs-CRP), total cholesterol, fasting glucose, and postprandial glucose (0.068, 0.974, 0.178, 0.677, respectively). There was no significant relation between the Gensini score and HbA1c levels (p=0.299), but there was a significant relation between the Gensini score and obesity (p=0.024). CONCLUSION: In our study, no significant relationship could be determined between the Gensini score and HbA1C, fasting and postprandial blood glucose levels, lipid profile, and hs-CRP levels in patients with nondiabetic ACSs.

Changes in serum natriuretic peptide levels after percutaneous closure of small to moderate ventricular septal defects.

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3 ± 14.3) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3 ± 78.6 versus 26.8 ± 15.6, P = 0.013). Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.

[Percutaneous closure of a ruptured right coronary sinus of Valsalva aneurysm]. / Yirtilmis sag koroner Valsalva sinüsü anevrizmasinin perkütan yolla kapatilmasi

Sinus of Valsalva aneurysm (SVA) is a rare disease that is mostly congenital in origin. The rupture of a SVA may occur and can eventually lead to death unless definite surgical treatment occurs. In this article, a ruptured and percutaneously treated SVA in a subject who underwent two consecutive corrective open cardiac surgeries due to a congenital heart disease was examined. An 18-year-old male was referred because of the complaint of dyspnea and fatigue. He underwent a complete repair of tetrology of Fallot before and a redo-repair of residual VSD three years before. A ruptured SVA was detected by transthoracic echocardiography and aortography. Percutaneous closure was successful by an Amplatzer muscular VSD occluder. Percutaneous treatment of a ruptured SVA may be an alternative technique to surgery in selected cases.

Thymosin beta 4 is associated with collateral development in coronary artery disease.

OBJECTIVES: Thymosin beta 4 (Tß4) plays an essential role in cardiac vessel development and is currently being developed as a therapeutic agent for the treatment of coronary artery disease (CAD) in some experimental studies. Thus, we aimed to investigate the association of serum Tß4 levels and collateral formation in patients presenting with severely stenotic CAD. METHODS: Thirteen patients with poor collateral development and 16 age- and sex-matched patients with good collateral development who had ≥ 95% stenosis in at least one major coronary artery on coronary angiogram (CAG) were enrolled in the study. The Gensini score was calculated for each patient by using CAG results. Collateral development was classified according to the Cohen-Rentrop method. Serum Tß4 levels were measured with enzyme-linked immune sorbent assay. RESULTS: There were no statistically significant differences between the two groups in regard to clinical and laboratory characteristics of the patients except for Tß4 levels. The Tß4 levels in the well-collateralized study group were found to be significantly higher than those of the poorly collateralized study group and serum Tß4 levels were positively correlated with the collateral development. CONCLUSIONS: Our findings suggest that serum Tß4 levels are significantly associated with the collateral development in severe CAD.

Tissue Doppler atrial conduction times and electrocardiogram interlead P-wave durations with varying severity of obstructive sleep apnea.

OBJECTIVES: Obstructive sleep apnea (OSA) has been reported to be associated with an increased risk of atrial fibrillation. The aim of this study was to investigate atrial electromechanical couplings in patients with OSA and the relationship between these parameters and P-wave dispersion (Pd). METHODS: One hundred twenty-six patients were enrolled in this study. All patients underwent polysomnographic examination. The apnea-hypopnea index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. An AHI score of 5 or more was diagnosed as OSA, and an AHI score of less than 5 was diagnosed as OSA (-). Thirty-nine of the patients had an AHI score of less than 5 (group 1), 42 of the patients had AHI score between 5 and 30 (mild and moderate, group 2), 45 of the patients had an AHI score more than 30 (severe, group 3). Atrial electromechanical coupling (PA), intra-atrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. P-wave dispersion was calculated from 12-lead electrocardiogram. RESULTS: Maximum P-wave duration was higher in group 3 compared with groups 2 and 1 (126.0 ± 16.7 vs 111.0 ± 12.5 [P < .001] and 126.0 ± 16.7 vs 99.9 ± 10.0 [P < .001], respectively). Maximum P-wave duration was higher in group 2 than in group 1 (111.0 ± 12.5 vs 99.9 ± 10.0, P < .001). P-wave dispersion was higher in group 3 compared with groups 2 and 1 (50.9 ± 11.5 vs 37.0 ± 8.6 [P < .001] and 50.9 ± 11.5 vs 27.9 ± 6.8 [P < .001], respectively). P-wave dispersion was higher in group 2 than in group 1 (37.0 ± 8.6 vs 27.9 ± 6.8, P < .001). Minimum P-wave duration did not differ between the groups. Atrial PA at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in group 3 than in group 2 (P < .001, P = .001, and P = .009, respectively). Lateral PA, septal PA, and RV PA were higher in group 2 compared with group 1 (P < .001, P = .003, and P = .009, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in group 3 compared with groups 2 and 1 (33.6 ± 12.1 vs 22.4 ± 9.4 [P < .001] and 33.6 ± 12.1 vs 14.9 ± 9.2 [P < .001], respectively). Interatrial electromechanical delay was longer in group 2 than in group 1 (22.4 ± 9.4 vs 14.9 ± 9.2, P = .001). There was a positive correlation between AHI and Pd, lateral PA, septal PA, RV PA, interatrial electromechanical delay, and left-sided intra-atrial electromechanical delay. CONCLUSION: Prolongation of electromechanical delay and increased Pd are associated with apnea-hypopnea index (AHI) and hence the severity of disease.

Thymosin beta4 levels after successful primary percutaneous coronary intervention for acute myocardial infarction.

OBJECTIVES: Thymosin beta4 (Tß4) has been shown to have an important role in healing of damaged tissues and promoting cardiomyocyte survival in acute coronary syndromes. We evaluated endogenous Tß4 levels in patients presenting with ST-elevation acute myocardial infarction (STEMI) before and after successful primary percutaneous coronary intervention (PCI). STUDY DESIGN: The study included 24 consecutive patients (7 females, 17 males; mean age 55.0±10.9 years) who underwent successful primary PCI for STEMI and 24 age- and sex-matched healthy controls (13 females, 11 males; mean age 57.5±11.7 years) with angiographically normal coronary arteries. To determine Tß4 levels, blood samples were obtained from STEMI patients on admission and 48 hours after successful PCI, and from controls immediately after coronary angiography. RESULTS: Compared to controls, baseline levels of high-density lipoprotein cholesterol (46.2±8.9 vs. 34.2±7.2 mg/dl, p<0.001) and Tß4 (2.9±1.5 vs. 1.5±1.0 µg/ml, p<0.001) were significantly lower, and white blood cell counts (7.6±2.2 vs. 11.4±3.0 10³/µl, p<0.001) were significantly higher in the STEMI group. After 48 hours of PCI, the mean Tß4 level increased significantly to 2.3±0.8 µg/ml (p<0.001) and became similar to that of the control group (p=0.068). There was a significant negative correlation between serum Tß4 and white blood cell count (r=-0.347, p=0.016). CONCLUSION: Considering the significant increase in serum Tß4 levels following successful primary PCI in patients with STEMI, Tß4 may prove to be a new marker in the assessment of reperfusion success in addition to those used currently.

Paraoxonase activity might be predictive of the severity of aortic valve stenosis.

BACKGROUND AND AIM OF THE STUDY: Aortic valve stenosis (AS) is the most common valvular heart disease in the western world, and in adults is invariably caused by the calcification of a normal tricuspid or congenital bicuspid valve. Calcific AS, as an active disease process, is characterized by lipid accumulation, inflammation and calcification that mimic atherosclerosis. Paraoxonase-1 (PON-1) is a high-density lipoprotein (HDL)-bound enzyme that exerts antiatherogenic properties by protecting low-density lipoprotein (LDL)-cholesterol from oxidative modification. The study aim was to examine the association between PON-1 activity and AS. METHODS: A total of 93 patients with angiographically normal coronary arteries was enrolled into the study. Transthoracic echocardiography was used to diagnose and grade the AS before the patients underwent selective coronary angiography. The patients were allocated to three groups of mild AS (n = 34), moderate AS (n = 31) and severe AS (n = 28). Paraoxonase activity was measured using a spectrophotometric technique. RESULTS: The mean PON-1 activity in patients with severe AS (64.4 +/- 29.8 U/l) was significantly lower than that in patients with mild and moderate AS (97.1 +/- 72.6 and 146.8 +/- 133.9 U/l; p = 0.03 and p = 0.002, respectively). Typically, PON-1 activity tended to be lower in moderate AS than in mild AS (p = 0.07). The serum PON-1 activity correlated positively with the aortic valve area, but negatively with the aortic mean and maximum gradients. CONCLUSION: The study results showed that PON-1 activity is lower in patients with calcific AS. In addition, PON-1 activity was inversely correlated with the severity of AS.

Effect of reperfusion therapy on index of myocardial performance in acute myocardial infarction: thrombolytics versus primary angioplasty.

It is known that primary angioplasty is more effective than thrombolytic therapy for the treatment of ST-segment elevation acute myocardial infarction. The aim of the present study is to compare the effects of the two strategies on the left ventricular functions using the Tei index (a combined myocardial performance index). Of 81 patients (11 female, mean age 52.7 +/- 11.9 years, and 70 male, mean age 54.8 +/- 11.5 years) matching the selection criteria, 41 patients were treated by primary percutaneous transluminal coronary angioplasty and stenting (group A, 41 patients) and 40 patients were treated by thrombolytic agents (streptokinase) (group B, 40 patients). All patients underwent a complete two-dimensional transthoracic echocardiographic and Doppler study in the left lateral decubitus position from multiple windows. There was no significant difference between the two groups in isovolumetric contraction time and ejection time. Isovolumetric relaxation time was 95.2 +/- 18.4 in group A and 116.2 +/- 28.1 in group B (P = 0.001) and the Tei index was 0.51 +/- 0.12 in group A and 0.59 +/- 0.16 in group B (P = 0.019). Isovolumetric relaxation time and Tei index were significantly higher in group B. Primary angioplasty is superior to thrombolytic therapy as assessed by the Tei index even in the first 3 h, with no apparent change in systolic function.