The Importance of Intra-aortic Pulse Pressure After Anterior ST-segment Elevation Myocardial Infarction

Objective

To evaluate the association of pulse pressure (PP) with mortality and major adverse cardiac events (MACE) in one-year period after anterior ST-elevation myocardial infarction (A-STEMI).

Methods

A total of 261 consecutive patients whose blood pressure was measured with the aid of a catheter before primary percutaneous coronary intervention (PPCI) between August 2016 and February 2017 were included in the study. The patients were divided into three groups according to pulse pressure (PP) (Group 1, PP<35 mmHg; Group 2, 35≤PP≤50 mmHg; Group 3, PP>50 mmHg).

Results

The mean age of the patients was 63.4±14.1 years, and 206 of them were male. The groups were similar in terms of age and diastolic blood pressure (DBP). The ratio of female patients in Group 1 was higher, and their systolic blood pressure (SBP) was lower than those from the other groups (P=0.005 vs. P=0.042). The rates of MACE and mortality were higher in Group 1. The predictive PP values were calculated to be 42.5 mmHg for development of MACE and 41.5 mmHg for mortality. One-year survival ratio was worse in Group 1 than in the others according to Kaplan-Meier analysis (P<0.001).

Conclusion

The values of PP which was measured intra-aortically in patients with A-STEMI were associated with mortality and MACE in the one-year follow-up period.

Plasma Endocan Levels in Patients With Isolated Coronary Artery Ectasia

Endocan is a soluble proteoglycan, secreted by human vascular endothelial cells. Endocan is a marker for vascular pathologies and an important mediator of angiogenesis, strongly associated with inflammation, vascular endothelial dysfunction, and atherosclerosis. The relationship between coronary artery ectasia (CAE) and endocan has not been evaluated. We aimed to investigate this association. Fifty-four patients with isolated CAE without coronary stenosis and 30 controls with normal coronary angiogram were included in this study. Endocan plasma concentrations were measured using an enzyme-linked immunosorbent assay. Patients with isolated CAE had significantly higher levels of endocan compared to the controls (18.9 ± 7.3 vs 15.6 ± 3.6 ng/mL; P = .007). There was a significant correlation between endocan levels and severity of isolated CAE according to the Markis classification ( r = -.593, P < .001). Plasma endocan levels may reflect the presence and severity of isolated CAE, suggesting that endocan may be involved in pathogenesis of isolated CAE.

A cost effective parameter for predicting the troponin elevation in patients with carbon monoxide poisoning: red cell distribution width

OBJECTIVE

Carbon monoxide (CO) poisoning is very common worldwide. Despite the fact that CO is known to have cardiotoxic effects, as it has non-specific symptoms; cardiotoxicity could easily be overlooked, especially when troponin is not measured. The present study aimed to evaluate the association between troponin I levels and red cell distribution width (RDW) levels, which can be measured rapidly, easily, and affordably in the Emergency Room (ER).

PATIENTS AND METHODS

This single-center observational study included a total of 504 consecutive patients, who presented to the ER due to CO poisoning between January 2011 and June 2015. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. Elevated troponin test levels, which measure >0.04 ng/ml for our laboratory, were accepted as positive.

RESULTS

Patients (mean age 37±14) were classified into two groups: those who had positive troponin levels (38%) and those that did not. Patients with positive troponin, who were older, had longer CO exposure time and higher creatinine, COHb and RDW levels at the index admission following CO poisoning than patients with negative troponin. In a multivariate logistic regression model with forward stepwise method, age, COHb level, CO exposure time, and RDW (HR=1.681, 95% CI: 1.472-1.934, p<0.001) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant in the univariate analysis and correlated with RDW.

CONCLUSIONS

In patients presenting to the ER with CO poisoning, RDW can be helpful for the risk stratification of troponin positivity.

Predictive Value of the Mehran Score for Contrast-Induced Nephropathy after Transcatheter Aortic Valve Implantation in Patients with Aortic Stenosis

BACKGROUND/AIMS

The Mehran risk score (MS) was adopted to predict the development of contrast-induced nephropathy (CIN) and includes clinical and procedural variables. In this study, we aimed to evaluate the value of MS in the prediction of CIN development after transcatheter aortic valve implantation (TAVI).

METHODS

Ninety-three patients (47 females; mean age, 77.2 ± 7.6 years) who underwent aortic valve replacement with TAVI for severe aortic stenosis in our center between June 2013 and November 2014 were included in the study. Patients were categorized into four risk groups based on MS: low (≤5), moderate (6-10), high (11-15), and very high (≥16).

RESULTS

CIN was recorded in 24 patients after TAVI (25.8%). The amount of contrast medium was significantly higher in the CIN+ group (p = 0.029), and total mortality was higher in the CIN+ group than in the CIN- group (20.1 vs. 2.9%, respectively; p = 0.024). In univariate analysis, diabetes mellitus, coronary artery disease, ejection fraction, baseline creatinine, baseline glomerular filtration rate, contrast medium volume, and MS were found to be significant risk factors for CIN (p < 0.05 for all). The receiver operating characteristic analysis of the significant variables in multivariate regression analysis revealed that the cutoff MS to predict the development of CIN was 13.0 (area under the curve, 0.654; 95% confidence interval, 0.495-0.758; sensitivity, 62%; specificity, 68%).

CONCLUSION

MS is a predictor of CIN development after TAVI. We think that the use of MS in clinical practice may decrease renal complications after TAVI.

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients

Background

GRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI).

Objective

The present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS.

Methods

We evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS).

Results

Systolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438).

Conclusion

End-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS.

The change in right ventricular systolic function according to the revascularisation method used, following acute ST -segment elevation myocardial infarction

OBJECTIVE

The level of right ventricular (RV) systolic function has prognostic importance in right ventricular ST-segment elevation myocardial infarction (RV-STEMI). This study aimed to evaluate the changes in RV systolic function in patients with RV-STEMI according to the revascularisation method used for their management.

METHODS

The first group consisted of 132 patients who received primary percutaneous coronary intervention (PPCI). The 78 patients who had received thrombolytic therapy (TT) in external centres before referral to our centre for PCI within three to 12 hours of RV-STEMI were included in the second group. All patients were evaluated by conventional and two-dimensional speckle-tracking echocardiography.

RESULTS

There were 172 male patients and their mean age was 63.7 ± 11.8 years. There were no significant differences between the two groups with regard to right ventricular systolic parameters at admission and at the one-month follow-up visit. The echocardiographic changes between admission and the one-month follow up were investigated for the patients included in the study groups. Mean values of each parameter observed at the one-month follow up were significantly increased compared to those at admission within each group.

CONCLUSION

Our study demonstrated that PCI within three to 12 hours following TT provided similar benefits on right ventricular systolic function compared to PPCI in patients with RV-STEMI.

The change in right ventricular systolic function according to the revascularisation method used, following acute ST -segment elevation myocardial infarction

OBJECTIVE

The level of right ventricular (RV) systolic function has prognostic importance in right ventricular ST-segment elevation myocardial infarction (RV-STEMI). This study aimed to evaluate the changes in RV systolic function in patients with RV-STEMI according to the revascularisation method used for their management.

METHODS

The first group consisted of 132 patients who received primary percutaneous coronary intervention (PPCI). The 78 patients who had received thrombolytic therapy (TT) in external centres before referral to our centre for PCI within three to 12 hours of RV-STEMI were included in the second group. All patients were evaluated by conventional and two-dimensional speckle-tracking echocardiography.

RESULTS

There were 172 male patients and their mean age was 63.7 ± 11.8 years. There were no significant differences between the two groups with regard to right ventricular systolic parameters at admission and at the one-month follow-up visit. The echocardiographic changes between admission and the one-month follow up were investigated for the patients included in the study groups. Mean values of each parameter observed at the one-month follow up were significantly increased compared to those at admission within each group.

CONCLUSION

Our study demonstrated that PCI within three to 12 hours following TT provided similar benefits on right ventricular systolic function compared to PPCI in patients with RV-STEMI.

Evaluation of myocardial contractility determination with tissue tracking echocardiography after levosimendan infusion in patients with poor left ventricular function and hemodynamics

BACKGROUND

The aim of this study was to assess the effect of conventional inotropic drugs compared to levosimendan using tissue tracking echocardiography in the early postoperative period for patients with low ejection fraction undergoing coronary artery bypass graft (CABG) surgery.

METHODS

We prospectively analyzed 115 patients (69 male, 46 female) who planned for elective coronary artery bypass surgery with low ejection fraction, ≤% 30, from September 2012 to December 2013. Patients were divided into two groups. Levosimendan was used at a loading dose of 15 μg/kg/min for the first twenty minutes, and continued at a maintenance dose of 0.2 μg/kg/min six hours before the anesthetic induction in group I (n = 47, 23 male, mean age 67.16 ± 4.72 years). Dopamine at 10 μg/kg/min and/or dobutamine at 10 μg/kg/min were used at the time of weaning from cardiopulmonary bypass in group II (n = 68, 47 male, mean age 65.43 ± 6.12 years). The patients were evaluated preoperatively and on the fifth postoperative day by transthoracic echocardiography. Patients were also evaluated just before the cardiopulmonary bypass and at the 12th and 24th hours on the first postoperative day by transesophageal echocardiography. Student t test and χ2 test were used for statistical analyses.

RESULTS

There were no significant differences in demographics and preoperative hemodynamic parameters between groups I and II. Hemodynamic and echocardiographic parameters were significantly better in group I receiving levosimendan, compared to group II.

CONCLUSION

Levosimendan enhances functional myocardial tissue mass and ensures positive hemodynamic effect in the early postoperative period in patients with low ejection fraction undergoing elective CABG.

The importance of contrast volume/glomerular filtration rate ratio in contrast-induced nephropathy patients after transcatheter aortic valve implantation

BACKGROUND/AIM

Transcatheter aortic valve implantation (TAVI) is a method which is increasingly applied in severe aortic stenosis treatment. The development of contrast-induced nephropathy (CIN) after TAVI increases morbidity and mortality rates. Within the scope of this study, the importance of the contrast medium volume to glomerular filtration rate (CV/GFR) ratio in determining the development of CIN and the amount of CV that could be applied was evaluated.

METHODS

Seventy-two patients (aged 78.6 ± 11.6 years; 38 females) who underwent aortic valve replacement with the TAVI method between June 2013 and August 2014 were included in the study. CIN was defined as an absolute increase in serum creatinine of >0.5 mg/dl or a relative increase of >25% within 48-72 h after TAVI. CIN+ and CIN-patients were classified into two groups. The χ(2) test, t test, Mann-Whitney U test, ROC analysis, and univariate and multivariate regression analyses were applied for statistical analyses.

RESULTS

CIN was detected in 16 patients (22%) in our study. Baseline creatinine, baseline GFR, the Mehran risk score, CV, and the CV/GFR ratio were determined as the predictive factors of CIN development. A CV/GFR ratio of 3.9 was specified to predict CIN development with 71% sensitivity and 80% specificity.

CONCLUSION

After TAVI, CIN may develop due to various reasons. In patients to whom TAVI was applied, the CV/GFR ratio may be a guideline helping to prevent the development of renal pathologies. The amount of contrast medium that can be given to a patient can be calculated in terms of baseline GFR.

Serum chitotriosidase activity in acute coronary syndrome

AIM

Inflammation is a critical participant in mediating all stages of cardiovascular disease. Studies related with chitotriosidase that was recently found to be relevant to arterial inflammation. In this study we evaluated activity of serum chitotriosidase in acute coronary syndrome patients and its relationship with cardiovascular events, cardiac enzymes and inflammatory indicators.

METHODS

We prospectively analyzed consecutive 30 patients with ST-segment elevation myocardial infarction, 30 patients with non ST-segment elevation myocardial infarction, 30 patients with unstable angina pectroris who were admitted to our intensive care unit and 30 healthy people (average age 56.86±10.44 years, 81 male) between Jaunary and June 2010. Details of baseline clinical characteristics, biochemical values, receiving treatment and basal ECG findings were recorded. Data of patients with coronary angiography were evaluated.

RESULTS

Cut off value of chitotriosidase was calculated 82.00 mmol·ml-1·h-1, with 83 percent sensitivity and 72 percent spesificity. The activity of chitotriosidase in acute coronary syndrome group was 88.85±23.08 mmol·ml-1 ·h-1, where as the control group was 68.47±28.44 mmol·ml-1·h-1, respectively p=0.001).The highest activity of chitotriosidase (96.11±19.77 mmol·ml-1·h-1) was found in ST-segment elevation myocardial infarction group and the minimal activity of chitotriosidase was in the control group (68.47±28.44 mmol·ml-1·h-1) (p= 0.001). The activity of chitotriosidase in ST-segment elevation myocardial infarction and non ST-segment elevation myocardial infarction groups were significantly higher than control group (p=0.001 and p=0.045). When acute coronary syndrome groups compared to control; a positive correlation was found between chitotriosidase activity and hs-CRP (r=0.21, p= 0.046), troponin T (r=0.25, p=0.016), creatine kinase-MB (r=0.20, p=0.059).

CONCLUSION

The activity of chitotriosidase is increased in acute coronary syndrome patients. Chitotriosidase is higher in ST-segment elevation myocardial infaction group than non ST-segment elevation myocardial infarction and unstable angina pectoris group.

Infective endocarditis and spondylodiscitis due to posterior nasal packing in a patient with a bioprosthetic aortic valve

Infective endocarditis (IE) is a severe form of heart valve disease and is associated with a poor prognosis and high risk of mortality. We report the first known case of bioprosthetic aortic valve endocarditis associated with spondylodiscitis as a result of posterior nasal packing coated with antibiotics but without systemic antibiotic prophylaxis.

A remnant sewing needle in the right ventricle as a cause of chest pain

Sewing needles, albeit a rare case of penetrating cardiac injury, are potentially life-threatening. We report a case of a self-inflicted remnant intracardiac sewing needle which is diagnosed with nonspecific chest pain and successfully extracted 23 months after its insertion.

Twiddler syndrome as a rare cause of implantable cardioverter defibrillator malfunction

Twiddler syndrome that causes device malfunction is a rare complication in patients with an implantable cardioverter defibrillator. In this case report, we present a patient who was referred to our hospital with palpitation and abdominal pulsation 7 months after implantable cardioverter defibrillator implantation.