S-R difference in V1-V2 is a novel criterion for differentiating the left from right ventricular outflow tract arrhythmias.

AIM: The correct estimation of the VA origin as RVOT or LVOT results in reduced ablation duration reduced radiation exposure and decreased number of vascular access. In our study, we aimed to detect the predictive value of S-R difference in V1-V2 for differentiating the left from right ventricular outflow tract arrhythmias. METHODS: We included 123 patients with symptomatic frequent premature ventricular outflow tract contractions who underwent successful catheter ablation (70 male, 53 female; mean age 46.2 ± 13.9 years, 61 RVOT, 62 LVOT origins). S-R difference in V1-V2 was calculated with this formula on the 12-lead surface ECG: (V1S + V2S) - (V1R + V2R). Conventional ablation was performed in 101 (82.1%) patients, CARTO electroanatomic mapping system was used in 22 (17.9%) patients. RESULTS: V1-2 SRd was found to be significantly lower for LVOT origins than RVOT origins (p < .001). The cutoff value of V1-2 SRd obtained by ROC curve analysis was 1.625 mV for prediction of RVOT origin (sensitivity: 95.1%, specificity: 85.5%, positive predictive value: 86.5%, negative predictive value: 94.5%). The area under the curve (AUC) was 0.929 (p < .001). CONCLUSION: S-R difference in V1-V2 is a novel and simple electrocardiographic criterion for accurately differentiating RVOT from LVOT sites of ventricular arrhythmia origins. The use of this simple ECG measurement could improve the accuracy of OTVA localization, could be beneficial for decreasing ablation duration and radiation exposure. Further studies with larger patient population are needed to verify the results of this study.

Morning blood pressure surge and arterial stiffness in newly diagnosed hypertensive patients.

OBJECTIVE: We aimed to investigate the relationship between the morning blood pressure (BP) surge and arterial stiffness in patients with newly diagnosed hypertension. SUBJECTS AND METHODS: Three hundred and twenty four (mean age 51.7 ± 11.4 years) patients who had newly diagnosed hypertension with 24 h ambulatory BP monitoring were enrolled. Parameters of arterial stiffness, pulse wave velocity and augmentation index (Aix) were measured by applanation tonometry and aortic distensibility was calculated by echocardiography. RESULTS: Compared with the other groups, pulse wave velocity, day-night systolic BP (SBP) difference (p < 0.001, for all) and hs-CRP (p = 0.005) were higher in morning BP surge high group. Aortic distensibility values were significantly lower in morning BP surge high group compared to the other groups (p < 0.05, for all). Morning BP surge was found to be independently associated with pulse wave velocity (ß = 0.286, p < 0.001), aortic distensibility (ß= -0.384, p < 0.001) and day-night SBP difference (ß = 0.229, p < 0.001) in multivariate linear regression analysis. CONCLUSIONS: We found independent relationship between morning BP surge and arterial stiffness which is a surrogate endpoint for cardiovascular diseases. The inverse relationship between morning BP surge and aortic distensibility and direct relation found in our study is new to the literature.

Plasma apelin-12 levels may predict in-hospital major adverse cardiac events in ST-elevation myocardial infarction and the relationship between apelin-12 and the neutrophil/lymphocyte ratio in patients undergoing primary coronary intervention.

OBJECTIVE: We aimed to investigate the compliance of plasma apelin-12 levels to show angiographic properties and hospital MACE in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS: The association of apelin-12 levels with the N/L ratio on admission was assessed in 170 consecutive patients with primary STEMI undergoing primary PCI. All patient SYNTAX scores and thrombolysis in myocardial infarction (TIMI) flow grades were also assessed. Patients were divided into two groups according to their TIMI flow grade. Patients with a TIMI 0-2 flow and TIMI 3 flow with grade 0/1 myocardial blush grade (MBG) score were defined as the no-reflow group and patients with TIMI grade 3 flow with ⩾2 MBG were considered as the normal flow group. RESULTS: Baseline apelin-12 levels were significantly lower in the no-reflow group than in the normal flow group (3.3±1.81 vs 6.2±1.74, p<0.001). In-hospital events, including death, myocardial infarction (MI) and re-infarction were significantly higher in patients in the no-reflow group than normal flow group (23% vs 7%, p<0.001). Apelin-12 level was negative correlated with the N/L ratio (r= -0.352, p<0.001), Hs-Crp (r=-0.272, p=0.01) and SYNTAX score (r= -0.246, p=0.029). In the multivariate regression analysis, apelin-12, presence of no-reflow and the SYNTAX score were independent predictors of in-hospital MACE (odds ratio [OR] 1.41, 95% confidence interval (CI) [1.27 to 1.67], p=0.001 for apelin-12, OR 1.085, [0.981 to 1.203], p<0.001 for no-reflow and OR 0.201, 95% CI [0.05 to 0.47], p= 0.004 for SYNTAX score). CONCLUSION: We have shown that lower apelin-12 level on admission is associated with higher SYNTAX scores and no-reflow phenomenon and may be used as a prognostic marker for hospital MACE in patients with STEMI.

Triglyceride glucose index is independently associated with aortic intima-media thickness in patients without known atherosclerotic cardiovascular disease or diabetes.

Background: The triglyceride-glucose (TyG) index is a reliable marker of insulin resistance. We aimed to investigate the relationship between the TyG index and aortic intima-media thickness (IMT) in individuals without diabetes mellitus and atherosclerotic cardiovascular disease undergoing transoesophageal echocardiography due to suspected structural heart disease.Methods: One hundred twenty-two patients enrolled in the study between January 2021 and June 2021. Patients were divided into two groups according to their median IMT; patients with an IMT equal to or less than 1.42 mm were low IMT group, and higher than 1.42 mm were high IMT group. Triglyceride-glucose index were higher in the high IMT group (8.69 ± 0.59 vs. 8.37 ± 0.53, p = .003).Results: Triglyceride-glucose index was correlated with IMT (r = 0.259, p = .005) and in binary logistic regression analysis age and TyG was independently associated with having high IMT (ß = 0.076, exp(B)=1.079 95%CI = 1.041-1.118, p < .001 and ß = 0.847, exp(B)= 2.334 95%CI= 1.048-5.199, p = .038, respectively).Conclusion: We found an independent relationship between TyG and IMT of the thoracic aorta, an early marker of subclinical atherosclerosis in patients without known atherosclerotic cardiovascular disease or diabetes. Therefore, the TyG index can identify high-risk subjects in the general population.

Thiols and disulfide levels are correlated with TIMI thrombus grade in non-ST elevation myocardial infarction patients.

Aim: We investigated the relationship between thrombolysis in myocardial infarction (TIMI) thrombus grade and thiol/disulfide levels. Materials & methods: 182 non-ST elevation myocardial infarction (NSTEMI) patients were divided into two groups; TIMI grade 0 patients who do not have any visible thrombus in their culprit vessels, and TIMI thrombus grade 1-5 patients. Results: Native and total thiol levels and disulfide to thiol ratio were higher in the low thrombus group. In addition, thrombus grade was positively correlated with disulfide to native and total thiol ratio and negatively with native and total thiol levels in NSTEMI patients. Conclusion: We can assert that thiol levels tend to decrease and the disulfide to thiol ratio increase, with the increasing thrombus burden in NSTEMI patients.

Association of serum adiponectin levels and coronary flow reserve in women with normal coronary angiography.

BACKGROUND: Women may have atypical clinical presentations and atypical risk factors of coronary artery disease. Adiponectin has anti-insulin-resistant properties and antiatherogenic effects. We investigated the association between serum adiponectin levels and coronary flow reserve (CFR) in women with normal coronary arteries. METHODS: CFR was assessed in 45 consecutive women (mean age 54.2+/-9.2 years) with normal epicardial coronary arteries by coronary angiography. Serum adiponectin, C-reactive protein, insulin, and glucose levels were examined and Homeostasis Model Assessment for Insulin Resistance index was calculated. Peak diastolic coronary flow velocities were measured in distal left anterior descending artery at baseline and after dipyridamole infusion by transthoracic pulsed wave Doppler echocardiography. CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities. A CFR value > or =2 was accepted as normal. RESULTS: Adiponectin levels were lower in patients with impaired CFR than those with normal CFR (7.1+/-2.3 vs. 13.8+/-6.7 microg/ml P<0.001). Adiponectin levels were correlated with CFR (r=0.531, P<0.001) and inversely correlated with C-reactive protein (r=-0.308, P=0.047), insulin (r=-0.426, P=0.008), and Homeostasis Model Assessment for Insulin Resistance index (r=-0.442, P=0.004). Adiponectin levels of < or =8.5 muU/ml had 83% sensitivity and 93% specificity [receiver operating characteristic area 0.084, P<0.001, 95% confidence interval (0.56-1.08)] for predicting impaired CFR. CONCLUSION: Decreased adiponectin levels are associated with impaired CFR in women with normal epicardial coronary arteries and hypoadiponectinemia may be a risk factor for impaired CFR in women.

A case of myotonic dystrophy presenting with ventricular tachycardia and atrial fibrillation.

Myotonic dystrophy type 1 (MD1) is an autosomal dominant disorder characterized by myotonia, progressive muscular weakness, cataract, and cardiac involvement. Cardiac involvement is common and includes conduction system abnormalities, supraventricular and ventricular arrhythmias, and less frequently, myocardial dysfunction and ischemic heart disease. A 54-year-old woman with a previous diagnosis of MD1 was admitted with palpitation, blood pressure of 157/118 mmHg, and a heart rate of 220 beats/min. Electrocardiography (ECG) showed ventricular tachycardia. Within minutes, hemodynamic collapse developed and electrical cardioversion was performed. Immediately following cardioversion, ECG showed atrial fibrillation, a slightly prolonged QT interval, and intraventricular conduction delay. After intravenous infusion of amiodarone, the rhythm converted to sinus. Transthoracic echocardiography showed significantly depressed left ventricular function, an ejection fraction of 25%, and normal coronary arteries. During electrophysiological study, atrium-His interval and His-ventricle interval were 120 msec was 54 msec, respectively, and monomorphic ventricular flutter was induced. An implantable cardioverter-defibrillator was placed. She was discharged in sinus rhythm.

Chronic statin treatment is a predictor of pre-interventional infarct-related artery patency in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention.

BACKGROUND: Beyond lipid-lowering effects, early statin treatment has beneficial effects on prognosis after acute coronary syndrome. Infarct-related artery (IRA) patency before percutaneous coronary intervention (PCI) is known to be a strong pre-dictor of improved clinical outcome. AIM: We aimed to investigate the effects of chronic statin treatment before admission on IRA patency after myocardial infarction. METHODS: In this study, 938 ST elevation myocardial infarction (STEMI) patients admitted to the hospital within the first 12 h of symptom onset were prospectively enrolled (male, n = 682; female, n = 256; mean age 58.6 ± 12.4 years). All patients underwent emergent primary PCI. Patients were divided into two groups based upon angiographic IRA patency. Impaired IRA patency was defined as Thrombolysis In Myocardial Infarction (TIMI) grade 0 and 1 flow (non-patent IRA group). Angiographic IRA patency was defined as TIMI 2 and 3 flow (patent IRA group). RESULTS: Previous statin usage was more frequent in the patent IRA group (n = 138; 71.9%), than in the non-patent IRA group (n = 110; 14.7%; p < 0.001). Pre-PCI IRA patency was independently associated with body mass index (odds ra-tio [OR] = 1.087, 95% confidence interval [CI] 1.005-1.176, p < 0.001), previous chronic statin use (OR 0.065, 95% CI 0.043-0.098, p = 0.039), ejection fraction (OR 1.041, 95% CI 1.018-1.064, p < 0.001), and SYNTAX score (OR 0.927, 95% CI 0.899-0.957, p < 0.001) in multivariate logistic regression analysis. CONCLUSIONS: Chronic pre-treatment with statins is a significant predictor of the IRA patency in patients with STEMI.

Impaired oscillometric arterial stiffness parameters in patients with coronary artery ectasia.

OBJECTIVE: The aim of this study was to investigate the oscillometric measurements of the elastic properties of the aorta in patients with isolated coronary artery ectasia (CAE). METHODS: This study included 137 patients (92 men and 45 women; mean age: 60.8±11.7 years) who underwent coronary angiography to investigate ischemic heart disease. The patients were divided into 3 groups; the first group consisted of 51 patients with CAE, the second group comprised 36 patients with coronary artery disease (CAD), and the third group was made up of 50 patients with normal coronary arteries. Aortic stiffness (AS) measurements, including pulse wave velocity (PWV) and augmentation index (AIx), were measured using the oscillometric method. RESULTS: The mean PWV was significantly higher in the CAE group compared with the CAD and control groups (9.1±2.3 vs. 8.2±1.3 and 8.0±1.6; p=0.008), whereas the median AIx was significantly lower in the CAE group compared with the CAD and control groups (10.0% [-3.0-63.0] vs. 15.5% [-2.0-57.0] and 21.5% [-1.0-45.0]; p=0.010). Multinomial logistic regression analysis demonstrated that gender, hypertension, highdensity lipoprotein cholesterol level, PWV, and AIx were independently associated with CAE. CONCLUSION: The oscillometric elastic properties of the aorta, including PWV and AIx, are impaired in patients with CAE.

Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries.

OBJECTIVE: A significant proportion of women with angina-like chest pain and angiographically normal coronary arteries have microvascular dysfunction as detected by reduced coronary blood flow reserve (CFR). Classical clinical risk factors of atherosclerosis poorly predict this scenario. We sought to assess whether increased epicardial fat tissue, which is a metabolically active organ, could be associated with impaired CFR in these patients. METHODS: We enrolled 68 women who underwent coronary angiography and had no obstructive coronary artery disease. Data about classical risk factors, insulin resistance and serum levels of C-reactive protein (CRP) and adiponectin were obtained. Stress tests were evaluated. Coronary flow velocities at baseline and under-induced hyperemia and epicardial fat thickness (EFT) were measured by transthoracic echocardiography within 48 h of angiography. CFR >or=2.0 was considered normal. RESULTS: Forty percent of women had reduced CFR suggestive of microvascular dysfunction and 60% had normal CFR. Menopause, hypertension and abnormal stress tests were significantly more prevalent, adiponectin level was significantly decreased, CRP, insulin resistance, and EFT were significantly increased in women with microvascular dysfunction as compared with those without. On multivariate regression analysis EFT emerged as the only independent predictor of microvascular dysfunction (P<0.0001). EFT of >0.45 cm had 85% sensitivity and 75% specificity to detect CFR <2 (P<0.0001). Traditional risk factors for atherosclerosis did not predict women with abnormal microvascular function. CONCLUSIONS: EFT has the potential to be an additional and easy diagnostic tool for risk stratification of women with chest pain and angiographically normal coronary arteries.