Yeni tanı dipper ve non-dipper hipertansif hastalarda strain analiz metoduyla sol ventrikül global sistolik fonksiyonlarının değerlendirilmesi

Non-dipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional (2D) strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and Methods: We included 42 newly diagnosed hypertensive patients without a previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non-dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by 2D speckle tracking method. Results: The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of left ventricular (LV) systolic function by GLS showed decreased values in non-dippers compared with dippers (-18.13±2.07 vs. -13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), nighttime systolic and diastolic blood pressures, 24-hr systolic blood pressure, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with LV GLS. Conclusion: An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain.Non-dipper hipertansiyon, artmış hedef organ hasarı ve olumsuz kardiyovasküler olaylarla ilişkilidir. Dipper ve non-dipper hipertansif hastalarda 2 boyutlu strain ekokardiyografi ile kardiyak hasar değerlendirilmesi, daha önce kapsamlı bir şekilde araştırılmamıştır. Biz daha önceden tedavi almamış, yeni tanı hipertansif hastalarda dipper ve non-dipper paternin miyokardiyal deformasyon strain parametreleri üzerine olan etkisini araştırdık. Gereç ve Yöntemler: Çalışmamıza daha önceden kardiyovasküler veya kronik hastalığı olmayan 42 yeni tanı hipertansif hastayı dâhil ettik. Hastalar 23 dipper ve 19 non-dipper olarak 2 gruba ayrıldı. 'Global longitudinal strain (GLS)', radyal strain ve sirkümferansiyel strain analizleri 2 boyutlu 'speckle tracking' metodu ile yapıldı. Bulgular: Çalışmaya dâhil edilen 42 hastanın (15 erkek), ortalama yaşı 54,5±9 idi. Sol ventrikül sistolik fonksiyonlarının analizinde dipper grupta GLS, non-dipper gruba göre anlamlı olarak daha yüksek bulundu (-18,13±2,07 vs. -13,7±1,95; p=0,001). Fakat radyal veya sirkümferansiyel strainde 2 grup arasında anlamlı fark yoktu. Gece ortalama arter basıncı, gece ve gündüz sistolik kan basıncı, 24 saat sistolik kan basıncı, dipping oranı, gece ortalama arter basınç düşme oranı, GLS ile korele bulundu. Fakat bu parametrelerden sadece dipping oranı, GLS ile bağımsız olarak ilişkili bulundu. Sonuç: İzole non-dipper kan basıncı paterni, miyokardiyal strain ile saptanan sol ventrikül fonksiyonlarında bozulmayla ilişkilidir

Which one is worse? Acute myocarditis and co-existing non-compaction cardiomyopathy in the same patient

WOS: 000422589400051PubMed ID: 26266155Non-compaction cardiomyopathy is a relatively rare cardiac condition known to be found in 0.12 per 100,000 cases characterized by increased trabeculations in the ventricular wall due to embryologic malformation predisposing malignant ventricular arrhythmias [1,2]. Although acute postviral myocarditis has been well-documented in the medical literature, co-existence of these two clinical entities is extremely uncommon [3-5]

Predictive value of C-reactive protein/albumin ratio for no-reflow in patients with Non-ST-elevation myocardial infarction

Introduction: The focus of this research was to explore the link between CRP (C-reactive protein)/albumin ratio (CAR), a novel inflammatory response marker, and no-reflow (NR) phenomena in non-ST elevation myocardial infarction (non-STEMI) patients during percutaneous coronary intervention (PCI). Methods: The current study recruited 209 non-STEMI participants who underwent PCI. The patients were divided into two groups based on their post-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade; those with and without NR. Results: In all, 30 non-STEMI patients (6.9%) had NR after PCI. CAR values were substantially greater in the NR group. The CAR was identified to be a determinant of the NR (OR: 1.250, 95% CI: 1.033-1.513, P = 0.02), although CRP and albumin were not independently related with NR in the multivariate analysis. In our investigation, low density lipoprotein-cholesterol levels and high thrombus burden were also predictors of the occurrence of NR. According to receiver operating characteristic curve evaluation, the optimal value of CAR was > 1.4 with 60% sensitivity and 47% specificity in detecting NR in non-STEMI patients following PCI. Conclusion: To the best of knowledge, this is the first investigation to demonstrate that the CAR, a new and useful inflammatory marker, can be utilized as a predictor of NR in patients with non-STEMI prior to PCI

Angio-seal used as a bailout for incomplete hemostasis after dual perclose ProGlide deployment in transcatheter aortic valve implantation

Background: The failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice. Methods: This research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared. Results: No significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P =.36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P =.14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P =.25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P =.34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P =.044). Conclusion: Finding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal “bailout” procedure. (Tex Heart Inst J. 2022;49(6):e217684)

Acute left main coronary artery occlusion following transcatheter aortic valve replacement without obvious risk factors of coronary obstruction

Transcatheter aortic valve implantation (TAVI) has emerged as a prominent alternative for patients with severe aortic stenosis, who are deemed to be at a greater risk for surgical interventions (1). However, extreme caution is recommended against the lethal complications, such as coronary obstruction (CO) or annulus rupture, associated with this procedure that need to be overcome urgently (1). Herein, we report an occlusion of acute left main coronary artery (LMCA) after TAVI, which was treated with triple stenting, due to immediate stent recoils

Predilatasyon, uygun stent çapı, postdilatasyon protokolü ile takılan absorb eriyebilen vasküler çatının uzun dönem gerçek yaşam takip sonuçları

OBJECTIVE: Bioresorbable vascular scaffolds (BVSs) have been a disappointment in the evolution of drug-eluting stents used in percutaneous coronary intervention because an excessive number of thrombotic complications have been reported. The aim of this study was to evaluate long-term clinical outcomes of the Absorb BVS in patients treated using a predilation, proper sizing, and post-dilation implantation technique. METHODS: The records of 110 patients who had a total of 150 Absorb BVSs implanted were retrospectively analyzed. The rate of major adverse cardiovascular events (MACEs), defined as the composite of cardiac death, target vessel myocardial infarction (MI), and target-lesion revascularization were studied using quantitative coronary angiography. RESULTS: Of the study population, 80% were male and the mean age was 60±11.3 years. The most common diagnosis was stable angina (84%). The median length of follow-up was 53 months (range: 46-59 months). The rate of predilation and postdilation was 100%, and 95%, respectively. The 4-year rate of MACEs was 20%: cardiac death in 3 patients (2.7%), target vessel MI in 9 (8.2%), and target lesion revascularization in 20 (18.2%). Definite device thrombosis occurred in 6 of 110 patients (5.5%). One case of very late scaffold thrombosis was observed at 47 months. A small BVS diameter (2.5 mm) was found to be the most powerful independent predictor of a MACE (p=0.05). CONCLUSION: The Absorb BVS was associated with an increased risk of adverse events, including late and very late device thrombosis, despite the use of a good implementation protocol.Amaç: Eriyebilen vasküler çatı (EVÇ), ilaç kaplı stent teknolojisinde en heyecan verici gelişme olarak son yıllarda önplana çıkmış fakat artmış tromboz komplikasyonları nedeniyle hayal kırıklığı yaşatmıştır. Bu çalışmada, çok büyükoranda predilatasyon-uygun çap postdilatasyon protokolü’neuyarak Absorb EVÇ yerleştirilen hasta grubunda uzun dönem klinik sonuçlar araştırılmıştır.Yöntemler: Bu geriye dönük çalışmaya 150 Absorb EVÇ yerleştirilen toplam 110 hasta dahil edildi. Uzun dönem takiptekardiyak ölüm, hedef damar miyokart enfarktüsü (ME), hedeflezyon revaskülarizasyonu olarak tanımlanan majör kardiyovasküler olaylar (MKO) değerlendirildi.Bulgular: Çalışmaya katılan hastaların %80’i erkek, ortalamayaş 60±11.3 yıldı. En sık tanı %84 kararlı anjinaydı. Ortancatakip süresi 53 aydı (aralık 46–59 ay). Hastaların predilatasyon, postdilatasyon oranları sırasıyla %100, %95’ti. Dört yıllıktakipte MKO oranı %20 bulundu. Hastaların 3’ünde (%2.7)kardiyak ölüm, 9’unda (%8.2) hedef damar ME ve 20’sinde(%18.2) hedef lezyon revaskülarizasyonu mevcuttu. Kesinçatı trombozu 6/110 (%5.5) hastada gözlemlendi. Bir hastada47. ayda çok geç dönem çatı trombozu izlendi. Küçük BVSçapı (2.5 mm) MKO’ların en güçlü öngördürücüsü saptandı(p=0.05).Sonuç: Absorb EVÇ, uygun yerleştirme protokolüne rağmen,artmış geç ve çok geç dönem çatı trombozunu da içerenolumsuz olaylarla ilişkilidir

Transkateter aort kapak değişimi öncesi sol ventrikül enjeksiyonu ile çok düşük doz kontrast kullanılarak bilgisayarlı tomografik anjiyografik görüntüleme: Görüntüleme için yeni bir teknik

Transcatheter aortic valve implantation (TAVI) has evolved as a novel procedure for the treatment of severe aortic stenosis. Since large-diameter catheters (18-24 F) are required for TAVI procedures, procedural evaluation of the peripheral vascular pathways and precise annular sizing is crucial both for patient selection and guidance of the intervention. However, the population is frequently frail and elderly, and these patients often have a greater prevalence of peripheral artery disease. A 50 to 140 mL intravenous contrast agent is required for computed tomographic angiography (CTA), which may induce contrast-induced nephropathy, particularly when performed in patients with chronic kidney disease

Evaluation of global left ventricular systolic function in dipper and newly diagnosed nondipper hypertensive patients

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Acute myocarditis or the kounis syndrome: Role of cardiac MRI and speckle-tracking echocardiography in diagnosis

Introduction: The Kounis syndrome and acute myocarditis are two distinct clinical entities, which could share nearly the same symptomatology as well as ECG (electrocardiography) and laboratory findings. Case Presentation: First case was a 39-year-old male presented with acute chest pain and inferolateral ST elevation on ECG. The second case was a 29-year-old male presented with chest pain and diffuses ST elevation. Diagnosis of acute myocarditis was achieved by demonstrating subepicardial contrast enhancement as well as atypical involvement in both of our clinical cases. Conclusions: We reported two cases in which specific imaging modalities (cardiac magnetic resonance imaging and speckle-tracking echocardiography) were used when the signs and symptoms were indistinguishable

Long-term comparison of everolimus- vs. novolimus-eluting bioresorbable vascular scaffolds

BACKGROUND The vast majority of clinical trials regarding bioresorbable vascular scaffold (BVS) use came from comparison of everolimus-eluting scaffolds with metallic stents, and it remains unclearwhether similar results would be true when a different type of BVS isused. This study sought to evaluate the long-term performance ofnovolimus-eluting bioresorbable vascular scaffolds (nBVSs) comparedwith everolimus-eluting bioresorbable vascular scaffolds (eBVS).METHODS A total of 140 patients with nBVS (n ¼ 202 before exclusion) and 98 patients with eBVS (n ¼ 135 before exclusion) wereincluded in current study. After propensity-score matching, 98 patients treated with 135 eBVSs were compared with 98 patients treatedwith 136 nBVSs. The primary outcome was the 3-year rate of majoradverse cardiovascular events, defined as the composite of cardiacdeath, target vessel myocardial infarction, and target lesionrevascularization