Association of CHA2DS2-VASc score with thrombus burden in patients with acute myocardial infarction undergoing SVG-PCI.

BACKGROUND: The rate of saphenous vein graft (SVG) occlusion within the first year of bypass graft surgery is 15%. The CHA2DS2-VASc score is used to predict the risk of thromboembolic events in patients with nonvalvular atrial fibrillation. We aimed to evaluate the predictive role of the CHA2DS2-VASc score in the estimation of intracoronary thrombus burden in patients with acute myocardial infarction (AMI) who underwent SVG-PCI. METHODS: We retrospectively evaluated 221 patients who were admitted with AMI and underwent PCI of SVGs at the Department of Cardiology in the Turkiye Yuksek Ihtisas Education and Research Hospital between 2012 and 2018. The study population was divided into two groups according to their Thrombolysis in Myocardial Infarction (TIMI) thrombus grade: low thrombus burden (LTB; TIMI 0-3) and high thrombus burden (HTB; TIMI 4 and 5). RESULTS: The study included 221 patients with a mean age of 63.3 ± 6.7 years. The patients with HTB had significantly higher CHA2DS2-VASc scores (p < 0.001) compared with LTB patients. Univariate and multivariate regression analysis demonstrated that both CHA2DS2-VASc score (OR: 1.573, 95% CI: 1.153-2.147, p = 0.004) as a continuous variable and a binary cut-off level of the CHA2DS2-VASc score > 3 (OR: 3.876, 95% CI: 1.705-8.808, p = 0.001) were significantly associated with HTB. The ability of the CHA2DS2-VASc score to predict HTB burden was evaluated by receiver-operating characteristics analysis curve analysis. The optimum cut-off value of the CHA2DS2-VASc score for predicting HTB was 3 (with a sensitivity of 67.9% and a specificity of 69.3%) according to the Youden index. CONCLUSION: The CHA2DS2-VASc score can be used as an easy practical tool to predict HTB in AMI patients undergoing SVG-PCI.

Comparison of the predictive accuracy of four different ECG algorithms in identification of true ablation site for the idiopathic right ventricular outflow tract tachycardias.

BACKGROUND: We aimed to investigate the accuracy of four algorithms in prediction of right ventricular outflow tract (RVOT) tachycardias in patients who successfully underwent radiofrequency catheter ablation. METHODS: Four algorithms; two with easy-applicability and having a memorable design (Dixit and Joshi), and two with more complex and detailed design (Ito and Zhang) were compared according to the predictive accuracy. RESULTS: Among 99 patients (mean age 36.5 ± 8.5 years, 39.4% male), there were 51 (51.5%) septal-located and 48 (48.5%) free-wall located RVOT tachycardia. Comparison of the predictive accuracy of the algorithms showed that Zhang (91.9%) was the best algorithm for prediction of either septal or free-wall located tachycardia. The second best algorithm was the Ito (77.7%) compared to Dixit (75.8%) and Joshi (70.7%). CONCLUSION: In patients with RVOT tachycardia, algorithms with a detailed design may predict the arrhythmia location better than the easy-applicable algorithms.

Usefulness of the Macruz Index for Predicting Successful Percutaneous Mitral Balloon Valvuloplasty in Patients with Mitral Stenosis.

OBJECTIVE: The aim of this study was to determine whether the Macruz index (P/P-R segment) could predict the severity of valvular involvement and the success of percutaneous mitral balloon valvuloplasty (PMBV) in patients with mitral stenosis (MS). SUBJECTS AND METHODS: Sixty-one patients with MS eligible for PMBV and 72 healthy subjects (61 females and 11 males) with sinus rhythm were enrolled into this study. PMBV was performed in all patients using a percutaneous transseptal antegrade approach and a multitrack balloon technique. The P/P-R segment ratio and echocardiographic variables were measured before and 48-72 h after the procedure. The optimal cutoff point for differences in the Macruz index to determine clinical success was evaluated by receiver operating characteristic analysis by calculating the area under the curve as giving the maximum sum of sensitivity and specificity for the significant test. RESULTS: In the patient group (mean age 42.9 ± 11.1 years), the preprocedural Macruz index was significantly higher than in the control group (2.79 ± 1.03 vs. 1.29 ± 0.11; p < 0.001). In the successful-procedure group (n = 53), the mean postindex value was significantly lower (2.12 ± 0.71 vs. 2.81 ± 1.0, p = 0.020), and the decrease in the Macruz index was significantly higher than in the unsuccessful-procedure group (p = 0.007). An index decrease of 0.105 was the best cutoff value to distinguish the successful-PMBV group from the unsuccessful- PMBV group (area under the curve = 0.888, 95% confidence interval 0.788-0.988, p < 0.001). CONCLUSION: The Macruz index was significantly higher in patients with MS compared to healthy subjects. A greater decrease in the Macruz index was associated with a successful PMBV.

Usefulness of notched duration to predict response to cardiac resynchronization therapy.

OBJECTIVES: The presence of notches in the biventricular paced QRS complex (BiP-QRS) from the posterolateral cardiac vein displays delays in the activation of the left ventricle and may consequently be linked with longer times of stimulus conduction. Our objective was to determine the relationship between the notch duration ≥ 0.1 mV in the BiP-QRS and the effectiveness of cardiac resynchronization therapy (CRT). DESIGN: A total of 210 patients, who underwent de novo CRT implantation previously and had ≥ 1 follow-up between August 2009 and February 2014, were enrolled in the study. Echocardiographic response to CRT was defined as "an increase of ≥ 5% in ejection fraction" and clinical response to CRT was defined as "an improvement ≥ 1 in New York Heart Association class without heart failure hospitalization after 6 months of CRT implantation." RESULTS: At a mean follow-up of 9.2 ± 2.1 months, 142 patients (67%) were classified as responders to CRT. BiP-QRS duration was significantly longer among non-responders compared with responders (p = 0.036). More of the non-responders have notched in their BiP-QRS than responders (63% vs. 40%, p = 0.002). Median duration of notch was significantly higher among non-responders (80 ms vs. 67.5 ms, p = 0.041). Notch duration > 67.5 ms was associated with 2.8 times higher non-response to therapy (odds ratio: 2.8; 95% confidence interval: 1.075-7.588, p = 0.035). CONCLUSIONS: Patients with notch duration greater than 67.5 ms are associated with poor response to CRT. Notch duration > 67.5 ms predicts non-response to therapy with 50.0% specificity and 72.1% sensitivity.

The effect of hemodialysis on electrocardiographic parameters.

BACKGROUND: Cardiovascular complications are the leading causes of premature deaths in hemodialysis patients. Due to rapid changes in volume and electrolyte concentration following dialysis, the some electrocardiographic (ECG) changes or arrhythmias might be seen. OBJECTIVE: To investigate the acute effects of hemodialysis on the ECG parameters in patients with chronic end-stage renal disease (ESRD). METHOD: We included the consecutive ESRD patients who underwent a hemodialysis. Before and after hemodialysis, some 12 lead ECG parameters were analyzed by two different cardiologists by using electronic digital caliper device. RESULTS: A total of 62 patients (mean 52 ± 15 years; 65% male) with ESRD undergoing hemodialysis were recruited to the study. P-wave amplitude, QRS amplitude, QRS duration, QTc dispersion, the sum of amplitudes in V1S + V5R derivations, total QRS amplitude, and duration were significantly greater in posthemodialysis patients compared to the prehemodialysis ones. However, T-wave amplitude and QTc duration were significantly lower in posthemodialysis patients. CONCLUSION: The ECG changes including prolangated QRS and increased QTc interval after hemodialysis should be kept in mind and assessed carefully in ESRD patients. Prolongation of these parameters may prove to be a further noninvasive marker of susceptibility to ventricular arrhythmias.

The effect of different circadian blood pressure rhythms on left ventricular systolic dyssynchrony in patients with newly diagnosed essential hypertension.

OBJECTIVES: Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. METHODS: One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. RESULTS: Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. CONCLUSION: Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

An alternative noninvasive technique for the treatment of iatrogenic femoral pseudoaneurysms: stethoscope-guided compression.

OBJECTIVE: latrogenic femoral pseudoaneurysm is a well-known vascular access site complication. Many invasive and noninvasive techniques have been proposed for the management of this relatively common complication. In this study, we aimed to evaluate efficiency and safety of stethoscope-guided compression as a novel noninvasive technique in the femoral pseudoaneurysm treatment. METHODS AND RESULTS: We prospectively included 29 consecutive patients with the diagnosis of femoral pseudoaneurysm who underwent coronary angiography. Patients with a clinical suspicion of femoral pseudoaneurysm were referred to colour Doppler ultrasound evaluation. The adult (large) side of the stethoscope was used to determine the location where the bruit was best heard. Then compression with the paediatric (small) side of the stethoscope was applied until the bruit could no longer be heard and compression was maintained for at least two sessions. Once the bruit disappeared, a 12-hour bed rest with external elastic compression was advised to the patients, in order to prevent disintegration of newly formed thrombosis. Mean pseudoaneurysm size was 1.7 +/- 0.4 cmx 3.0 +/- 0.9 cm and the mean duration of compression was 36.2 +/- 8.5 minutes.Twenty-six (89.6%) of these 29 patients were successfully treated with stethoscope-guided compression. In 18 patients (62%), the pseuodoaneurysms were successfully closed after 2 sessions of 15-minute compression. No severe complication was observed. CONCLUSION: Stethoscope-guided compression of femoral pseudoaneurysms is a safe and effective novel technique which requires less equipment and expertise than other contemporary methods.

The predictive value of MAPH score for determining thrombus burden in patients with non-ST segment elevation myocardial infarction.

BACKGROUND: A high thrombus burden has been connected with poor clinical events in patients with non-ST segment elevation myocardial infarction (NSTEMI). In patients with STEMI, a high MAPH score has been associated with a large thrombus burden. However, the predictive value of the MAPH score in determining the thrombus burden in patients with NSTEMI is unclear. The present report aimed to evaluate the prognostic role of the MAPH score in the estimating coronary thrombus burden in NSTEMI patients. The study patients were split into two groups according to their thrombus grade. The low shear rate (LSR) and high shear rate (HSR) were estimated by haematocrit levels and serum total protein levels. The MAPH score was calculated by adding mean platelet volume (MPV) levels and age, in addition to total protein and haematocrit. RESULTS: The patients with a high thrombus burden (HTB) had a higher LSR, higher HSR and higher MAPH score compared to patients with low thrombus burden. MAPH score was found to be an independent predictors of HTB in Model 1 (OR: 1.124, 95% CI: 1.011-1.536; p = 0.039) and Model 2 (OR: 1.236; 95% CI: 1.002-1.525; p = 0.047). The cut-off value of the MAPH score for predicting HTB was 2 based on the Youden index. CONCLUSIONS: The MAPH score, which calculated by adding MPV levels and age, in addition to total protein and haematocrit, is a novel, easily accessible score. The MAPH score at both LSR and HSR was an independent predictor of HTB.

Documentation of impaired coronary blood flow in chronic obstructive pulmonary disease patients.

BACKGROUND: In the current study, the effects of moderate to severe chronic obstructive pulmonary disease (COPD) on coronary blood flow in patients with angiographically proven normal coronary arteries was evaluated. METHODS AND RESULTS: A total of 85 patients with moderate to severe COPD and 39 age- and sex-matched control partcipants, who underwent diagnostic coronary angiography and found to have normal epicardial coronary angiogram constituted the COPD and control groups, respectively. The 2 groups were compared for Thrombolysis In Myocardial Infarction (TIMI) frame counts in each major coronary artery. The TIMI frame count of the COPD group was significantly higher than that of control group for all 3 major individual coronary arteries: left anterior descending (corrected), 37+/-13 vs 20+/-4; right coronary artery, 32+/-14 vs 21+/-4; and left circumflex artery, 34+/-12 vs 20+/-5, (P<0.001 for all). In addition, TIMI frame counts in individual coronary arteries were found to be positively correlated with forced expiratory volume 1 s percent, serum high sensitive C-reactive protein and fibrinogen concentrations, in the COPD group. CONCLUSIONS: Our findings suggest that an increased slow coronary flow might be a manifestation of harmful effects of COPD on the coronary circulation, regardless of the underlying mechanism.

[The relationship between insulin resistance and left ventricular systolic and diastolic functions and functional capacity in patients with chronic heart failure and metabolic syndrome]. / Kronik kalp yetersizligi olan metabolik sendromlu hastalarda insülin direncinin sol ventrikül sistolik ve diyastolik fonksiyonu ve fonksiyonel kapasite ile iliskisi.

OBJECTIVES: The relationship between chronic heart failure (CHF) and insulin resistance (IR) has long been recognized. We examined the relationship of IR with left ventricular (LV) systolic and diastolic functions and functional capacity of CHF patients with metabolic syndrome. STUDY DESIGN: The study included 50 nondiabetic CHF patients with metabolic syndrome (NYHA class I-III; 40 men, 10 women; mean age 60+/-10 years). Metabolic syndrome was diagnosed according to the AHA/NHLBI (American Heart Association/National Heart, Lung, Blood Institute) criteria. Insulin resistance was determined by the homeostasis model assessment (HOMA). Pulse-wave Doppler echocardiography and tissue Doppler imaging were performed to assess LV structure and functions. RESULTS: Patients with LV ejection fraction 40% (n=25). Fasting plasma insulin concentrations and HOMA-IR did not differ significantly in this respect. No significant differences were found in LV geometrical patterns, diastolic and systolic functions in patients with (HOMA >or=2.7; n=19) or without (HOMA <2.7; n=31) HOMA-IR. However, patients with HOMA-IR had a lower NYHA functional capacity (p<0.0001). HOMA-IR showed significant increases in parallel with NYHA functional class. CONCLUSION: Our findings suggest that IR in CHF patients with metabolic syndrome is not associated with LV systolic and diastolic functions, but is strongly linked with worsening in NYHA functional capacity.

Diurnal rhythm of blood pressure in patients with polycythemia vera.

AIMS: Polycythemia vera increases the risk of hypertension, but there is limited information about the effect on daily blood pressure fluctuations. This study aimed to demonstrate how diurnal blood pressure rhythm is affected in polycythemia vera patients. METHODS: Fifty (50) patients (33 men; mean age 48 ± 15 years) with a diagnosis of polycythemia vera and 51 age and sex-matched healthy subjects for the control group were prospectively evaluated. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were evaluated by ambulatory blood pressure monitoring (ABPM) as average 24-hour, daytime and nighttime measures. RESULTS: Average 24-hour SBP and DBP, daytime SBP and DBP were similar in both groups. However, nighttime SBP and DBP were significantly higher in the polycythemia vera group compared with the control group (125.3 ± 17.2 and 73.7 ± 12.2 vs. 118.9 ± 12.2 and 69.5 ± 8.5; P = 0.034 and P = 0.044). Both nocturnal SBP fall and nocturnal DBP fall were blunted in the polycythemia vera group compared with the control group (-6.9 ± 8.9 and -11.3 ± 12.2 vs. -11.6 ± 7.7 and -16.3 ± 12.0, respectively). Both hemoglobin and hematocrit levels were positively correlated with nocturnal SBP fall (r = 0.306, P = 0.002 and r = 0.355, P < 0.001; respectively) in all patients. CONCLUSION: We found that the polycythemia vera group had significantly decreased nocturnal dipping compared with healthy controls. The SBP fall was also positively correlated with hemoglobin and hematocrit levels.

Decreased plasma concentrations of adiponectin in patients with slow coronary flow.

Adiponectin has multiple protective effects on vascular endothelium through anti-inflammatory and anti-atherogenic properties. Recent data suggested that endothelial activation and inflammation may contribute to the pathogenesis of slow coronary flow (SCF). Therefore, we investigated whether adiponectin plasma concentrations were decreased in patients with SCF compared to subjects with normal coronary flow. The study population consisted of 35 patients with angiographically documented SCF in all three coronary arteries and 35 sex- and age-matched cases with normal coronary flow. Coronary flow rates of all participants were determined by Thrombolysis in Myocardial Infarction (TIMI) frame count. Plasma adiponectin concentrations were measured by an enzyme-linked immunosorbent assay method using commercially available adiponectin kits. There were no statistically significant differences between the patients with SCF and the subjects with normal coronary flow in terms of demographic characteristics and cardiovascular risk factors (P>0.05). Plasma adiponectin concentrations of patients with SCF were found to be significantly lower than those with normal coronary flow (4.77+/-3.86 mg/ml vs 10.8+/-6.60 mg/ml, P=0.001, respectively). Plasma adiponectin levels were correlated significantly and inversely with mean TIMI frame count in patients with SCF (r= -0.441, P=0.008). Furthermore, the Receiver Operator Characteristics curve of adiponectin concentrations showed that an adiponectin <4.6 mg/ml is associated with SCF with a sensitivity of 68.6%, specificity of 82.9%, positive predictive value of 80.0%, and negative predictive value of 72.5%. Our findings suggest that endothelial inflammation may play a role in the pathogenesis of SCF phenomenon.

The use of three-dimensional echocardiography in the visualization of pseudoaneurysm of the mitral-aortic intervalvular fibrosa.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIF) is an uncommon but serious complication of aortic valve endocarditis. A 23-year-old woman was referred to our institution with the diagnosis of aortic valve endocarditis thought to be complicated by an aortic root abscess. Two-dimensional transthoracic echocardiography revealed a vegetation attached to the left coronary cuspis of the aortic valve and a false aneurysm-like structure in the MAIF at the left ventricular outflow tract. The diagnosis of MAIF pseudoaneurysm was confirmed by three-dimensional echocardiography. The patient died a few hours after admission because of worsening of her neurological status. An abscess-like structure detected in a patient with aortic valve endocarditis should be differentiated from a pseudoaneurysm of the MAIF.

Impact of plasma adiponectin levels to the presence and severity of coronary artery disease in patients with metabolic syndrome.

OBJECTIVES: Adiponectin is thought to serve a protective function for the coronary endothelium by inhibiting many of the crucial steps in atherosclerotic process. Previous research has indicated an increased risk of coronary artery disease (CAD) in patients with metabolic syndrome (MetS). The objective of this study was to investigate whether plasma adiponectin concentrations were associated with the presence and severity of CAD in patients with MetS undergoing coronary angiography. METHODS: We measured plasma adiponectin levels in 167 consecutive patients with MetS undergoing coronary angiography. The severity of coronary atherosclerosis was defined by using Gensini score system. RESULTS: CAD was found in 70.1% of the patients. Patients with significant CAD had lower plasma adiponectin concentrations than those without CAD (4.14+/-3.83 vs. 8.94+/-6.63 microg/ml, P<0.001). Multiple regression analysis demonstrated that plasma adiponectin level was independently associated with CAD (odds ratio: 0.86; 95% confidence interval: 0.78-0.94; P=0.001). Plasma adiponectin levels were inversely related to the Gensini score (rho: -0.480, P<0.001) and predicted the severity of coronary atherosclerosis independent of other risk factors (beta: -0.054; 95% confidence interval: -0.074--0.034; P<0.001). CONCLUSIONS: These findings suggest that hypoadiponectinemia may play a role in the development of coronary atherosclerosis and the observation of adiponectin levels may be indicative of the presence of significant CAD in patients with MetS.

Relation of admission QRS duration with development of angiographic no-reflow in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous interventions.

BACKGROUND: Although QRS-complex changes during ischemia have been described previously, their relation with no-reflow is not clear. PURPOSE: To evaluate relation of admission QRS duration with angiographic no-reflow, we studied 162 patients who underwent primary angioplasty. METHODS: Twelve-lead electrocardiogram with a paper speed of 50 mm/s was recorded on admission and repeated after angioplasty. Patients were divided into reflow and no-reflow groups based on postangioplasty coronary thrombolysis in myocardial infarction flow grade. RESULTS: Patients in the no-reflow group (26 patients) were older (P = .001) and had significantly longer pain-to-balloon interval (P = .007). The patients in the no-reflow group had significantly longer QRS duration on admission electrocardiogram compared with patients in the reflow group (interquartile range, 80-93 [median, 84] milliseconds vs 60-80 [median, 76] milliseconds, respectively; P < .001). After adjusting all variables, QRS duration on admission was found to be independently related to angiographic no-reflow (odds ratio, 1.07; 95% confidence interval, 1.02-1.12; P = .003). CONCLUSION: QRS duration on admission may be valuable in predicting no-reflow.

[The effect of plasma asymmetric dimethylarginine (ADMA) level and L-arginine/ADMA ratio on the development of coronary collaterals]. / Plazma asimetrik dimetilarginin (ADMA) düzeyi ve L-arginin/ADMA oraninin koroner kollateral gelisimi üzerine etkisi.

OBJECTIVES: It has been shown that asymmetric dimethylarginine (ADMA), an endogenous competitive antagonist of nitric oxide (NO) synthase, inhibits angiogenesis by reducing the production and bioavailability of NO. We investigated the effect of plasma ADMA level and L-arginine/ADMA ratio on the development of coronary collateral arteries. STUDY DESIGN: The study consisted of 94 patients (66 males, 28 females; mean age 59+/-11 years) who underwent coronary angiography for suspected coronary artery disease and were found to have severe stenosis (>95%) in at least one major coronary artery. The patients were evaluated in two groups with poor (Rentrop score 0-1, n=44) and good (score 2-3, n=50) coronary collateral circulation according to the Rentrop collateral scoring system. Plasma levels of ADMA and L-arginine were measured by high-performance liquid chromatography. RESULTS: The two groups were similar with regard to basal characteristics and cardiovascular risk factors (p>0.05) except for stable angina, which was more common in patients with Rentrop score 2-3 collateral circulation (p<0.001). Despite similar L-arginine levels (p>0.05), patients with Rentrop score 0-1 had a significantly higher ADMA level (p=0.003) and lower L-arginine/ADMA ratio (p=0.019). Multivariate logistic regression analysis showed that plasma ADMA concentration was an independent predictor of coronary collateral development (odds ratio=0.674; 95% confidence interval=0.508-0.894; p=0.006). CONCLUSION: Elevated plasma ADMA concentrations are associated with a poorly developed coronary collateral circulation, suggesting that dysregulation of the NO synthase pathway may result in impaired collateral development.

Relation Between TRCA Complication Rates and Peak ACT Levels Stratified According to the BMI Tertiles.

We evaluated the efficacy and safety of the fixed dose of 5000 IU unfractionated heparin (UFH) represented as peak activated clotting time (ACT) according to the body mass index (BMI) tertiles in patients undergoing diagnostic transradial coronary angiography (TRCA). A total of 422 patients were included in the present study, 84 in the normal weight group, 218 in the overweight group, and the 120 in the grades 1 and 2 obesity groups. Radial artery occlusion (RAO) was observed in 29 (6.8%) patients and the hematoma was observed in 43 (10.1%) patients. The rate of RAO and hematoma did not differ across the BMI tertiles ( P = .749 and P = .066). Also, peak ACT and procedure duration did not differ between the study groups ( P = .703 and P = .999). The only independent predictor of hematoma was sheath/radial artery diameter ( P = .011) and the independent predictors for RAO were peak ACT, sheath/radial artery diameter, and procedure duration ( P = .001, P = .028, and P < .001, respectively). In conclusion, a fixed dose of 5000 IU UFH is safe and effective regardless of the BMI in diagnostic TRCA procedure.

The impact of admission cystatin C levels on in-hospital and three-year mortality rates in acute decompensated heart failure.

BACKGROUND: Although tremendous advances have been made in preventative and therapeutic approaches in heart failure (HF), the hospitalisation and mortality rates for patients with HF is high. The aim of this study was to investigate the association between cystatin C and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and in- and out-of-hospital mortality rates in acute decompensated HF (ADHF). METHODS: Between February 2008 and November 2011, 57 consecutive patients who were admitted with ADHF were included in this prospective study. These patients were clinically followed up every three months by means of visits or telephone interviews. The primary clinical endpoint of this study was any death from heart failure rehospitalisation and/or other causes. RESULTS: The subjects who died during the in-hospital follow up were younger than the survivors (47.4 ± 17.5 vs 60.8 ± 15.8, p = 0.043). There was a notable correlation between plasma cystatin C and NT-proBNP levels (r = 0.324, p = 0.014) and glomerular filtration rate (GFR) (r = -0.638, p < 0.001). Multivariate logistic regression analysis revealed that only cystatin C level [odds ratio (OR): 12.311, 95% confidence interval (CI): 1.616-93.764, p = 0.015] and age [OR: 0.925, 95% CI: 0.866-0.990, p = 0.023] were linked to in-hospital mortality rate. In the multivariate Cox proportional hazard model, only admission sodium level appeared as a significant independent predictor of death during the 36-month follow up [hazard ratio: 0.937, 95% CI: 0.880-0.996, p = 0.037]. CONCLUSION: Evaluation of admission cystatin C levels may provide a reliable prediction of in-hospital mortality, compared to estimated GFR or NT-proBNP levels among patients with ADHF. However, in this trial, during long-term follow up, only admission sodium level significantly predicted death.

Asymmetric dimethylarginine plasma concentrations and L-arginine/asymmetric dimethylarginine ratio in patients with slow coronary flow.

OBJECTIVE: Elevated levels of nitric oxide synthase inhibitor, asymmetric dimethylarginine (ADMA) is considered to be a marker of endothelial dysfunction and increased risk of cardiovascular disease. Recent reports have implicated endothelial dysfunction as an underlying pathophysiological mechanism of slow coronary flow (SCF) phenomenon. Accordingly, we investigated plasma L-arginine, ADMA concentrations and L-arginine/ADMA ratio in patients with SCF in comparison with participants having normal coronary flow. METHODS: We measured plasma levels of L-arginine and ADMA by high-performance liquid chromatography in 31 participants with SCF and 31 age and sex matched control participants with normal coronary flow. Coronary flow was quantified using the thrombolysis in myocardial infarction (TIMI) frame count method. RESULTS: The patients with SCF were detected to have significantly higher concentrations of plasma ADMA (P=0.006) and lower L-arginine/ADMA ratio compared with participants with normal coronary flow (P=0.002). In addition, both ADMA and L-arginine/ADMA ratio were significantly correlated with mean TIMI frame count and TIMI frame count for each coronary artery in patients with SCF and multivariate regression analysis identified plasma ADMA as an independent predictor for SCF. In the receiver operator characteristics curve analysis, patients with SCF were detected by plasma ADMA level with a sensitivity, specificity of 64.5%, 74.2%, at a cut-off of >2.4 micromol/l and L-arginine/ADMA ratio with a sensitivity, specificity of 77.4%, 67.7% at a cut-off of <36.6. CONCLUSION: Our findings provide evidence to support the hypothesis that endothelial dysfunction may be an important factor in the pathogenesis of SCF.

Comparison of the electrocardiographic features of complete left bundle branch block in patients with ischemic and nonischemic left ventricular dysfunction.

BACKGROUND: Differentiating ischemic (ILVD) from nonischemic left ventricular dysfunction (NILVD) is important prognostically and therapeutically but might be difficult clinically. The differentiating role of electrocardiographic (ECG) features in the presence of left bundle-branch block (LBBB) is debatable on differentiating ILVD from NILVD. OBJECTIVE: The present study assessed whether there is the role of certain ECG features in differentiating ILVD from NILVD in the presence of the complete LBBB. METHODS AND RESULTS: Patients who had LBBB were divided into two groups based on the presence and type of left ventricular dysfunction; (1) ILVD group (49 patients; 20 female; age: 65 +/- 11 years) and (2) NILVD group (49 patients; 22 female; age: 59 +/- 12 years), and numerous ECG features were compared. Most of these ECG features did not show any difference between the groups except for following ECG findings; the voltage of R wave in V6 were statistically higher in NILVD group compared ILVD group (p: 0.03); the depression of the ST-J point by more than 0.2 mV in V6 were also frequently observed in NILVD group compared ILVD group (5/ 10% vs 19/ 39% , p: 0.001); and the notching in the ascending or descending limb of the S wave in V1-4 leads were more in ILVD group (18/ 36% vs 8/ 16% p: 0.03; 9/ 16% vs 2/ 4%, p: 0.03, respectively). CONCLUSION: In the current study, although some ECG findings were found to be useful, ECG features in the presence of complete LBBB had poor value in differentiating ILVD from NILVD.