Association Between Bifurcation Angle and Coronary No-reflow Following Primary Percutaneous Coronary Intervention in Patients

Objective:Percutaneous coronary intervention (PCI) has become the treatment method for patients presenting with ST elevation myocardial infarction (STEMI). One of the well-known complications of PCI is no-reflow. Studies demonstrated a relationship between endothelial dysfunction and disturbed vascular flow due to angulation of vascular tree. Although the relationship between hemodynamic alterations and coronary angulation is evident, there is a lack of detailed analysis in terms of hemodynamic changes between vascular geometry and coronary no-reflow. We aimed to elucidate the relationship between vascular geometry and coronary no-reflow.Method:We reviewed PCI database of our hospital and enrolled a total of 120 patients with STEMI, who developed no-reflow following PCI, and sex and age matched 80 patients with normal flow. For each group, demographic and clinical characteristics, laboratory values and two dimensional quantitative coronary angiography measurements were evaluated.Results:Patients with no-reflow had a higher prevalence of hypertension and diabetes mellitus. In addition, serum C-reactive protein levels were higher in patients with no-reflow compared to patients with normal flow (p<0.001). On the other hand, serum hemoglobin levels were significantly lower in patients with no-reflow compared to patients with normal flow (p<0.001). With respect to 3 dimensional coronary measurements, calculated bifurcation angle of left anterior descending artery (LAD) and circumflex artery (CX) was significantly wider in the no-reflow group than in the control group [110.9° (21.8°) vs. 85.9° (15.8°), p<0.001].Conclusion:Our data showed that a strong association existed between bifurcation angle of LAD-CX and no-reflow phenomenon in STEMI patients who underwent PCI

Zwiększone stężenie w osoczu asymetrycznej dimetyloargininy wiąże się z poszerzeniem aorty wstępującej: badanie kliniczno-kontrolne

Background: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. Aim: We aimed to determine plasma ADMA levels in patients with ascending aorta dilatation in comparison to those without aorta dilatation, and to evaluate the diagnostic, predictive, and prognostic value of serum ADMA level for aorta dilatation. Methods: This was a cross-sectional case-control study. A total of 104 consecutive patients (female/male, 35/69; mean age, 62.75 ± 13.11 years) diagnosed with ascending aorta dilatation (≥ 4.5 cm) on echocardiography (case group), and 52 age-and gender-matched patients (female/male, 17/35; mean age, 63.44 ± 7.56 years) with normal aorta dimensions (≤ 3.8 cm) (control group) were included. Routine biochemical and haematological analysis in addition to measurement of serum ADMA level were performed. Results: The mean diameter of ascending aorta measured on echocardiography was 4.95 ± 0.57 cm and 3.34 ± 0.36 cm in patients with aorta dilatation and those without aorta dilatation, respectively (p &lt; 0.001). Serum ADMA level was significantly higher in patients with aorta dilatation than in the control group (1.70 ± 1.12 μmol/L vs. 0.79 ± 0.76 μmol/L, respectively, p &lt; 0.001). There was significant positive correlation between ADMA level and aortic diameter in Spearman correlation analysis (r = 0.317, p &lt; 0.001). In linear regression analysis, ADMA was found to be a significant independent predictor of aorta diameter (Beta = 0.26, p &lt; 0.001). Receiver-operator characteristic curve analysis also revealed that serum ADMA cut-off level over 0.29 μmol/L predicts aorta dilatation (≥ 4.5 cm) with 94% sensitivity and 92% specificity and with high ac­curacy (area under curve: 0.786; 95% confidence interval: 0.709–0.863, p &lt; 0.001). Conclusions: Serum ADMA level is diagnostic for ascending aorta dilatation with high sensitivity and specificity, and should be considered for use in clinical diagnosis of aorta dilatation.  Wstęp: Asymetryczna dimetyloarginina (ADMA) jest endogennym inhibitorem syntazy tlenku azotu. Cel: Badanie przeprowadzono w celu oznaczenia osoczowego stężenia ADMA u chorych z poszerzeniem aorty wstępującej w porównaniu z osobami bez poszerzenia aorty oraz oceny diagnostycznej, predykcyjnej i prognostycznej wartości stężenia ADMA w odniesieniu do poszerzenia aorty. Metody: Do przekrojowego badania kliniczno-kontrolnego włączono 104 kolejnych pacjentów (kobiety/mężczyźni: 35/69; średnia wieku: 62,75 ± 13,11 roku) z rozpoznaniem poszerzenia aorty wstępującej (≥ 4,5 cm) ustalonym na podstawie ba­dania echokardiograficznego (grupa przypadków) oraz 52 osoby dopasowane pod względem wieku i płci (kobiety/mężczyźni: 17/35; średnia wieku: 63,44 ± 7,56 roku) z prawidłowymi wymiarami aorty (≤ 3,8 cm) (grupa kontrolna). Oprócz oznaczenia stężenia ADMA w osoczu wykonano rutynowe badania biochemiczne i hematologiczne. Wyniki: Średnie wymiary aorty wstępującej w badaniu echokardiograficznym wynosiły 4,95 ± 0,57 cm i 3,34 ± 0,36 cm, odpowiednio u chorych z poszerzeniem aorty i u osób bez poszerzenia aorty (p &lt; 0,001). Stężenie ADMA w osoczu były istotnie wyższe u pacjentów z poszerzeniem aorty niż w grupie kontrolnej (odpowiednio 1,70 ± 1,12 μmol/l vs. 0,79 ± 0,76 μmol/l; p &lt; 0,001). W analizie korelacji Spearmana wykazano istotną dodatnią zależność między stężeniem ADMA a poszerzeniem aorty (r = 0,317; p &lt; 0,001). W analizie regresji liniowej stwierdzono, że stężenie ADMA jest istotnym niezależnym czynnikiem predykcyjnym wymiaru aorty (Beta = 0,26; p &lt; 0,001). Ponadto, analiza krzywych ROC wykazała, że wartości powyżej punktu odcięcia stężenia ADMA w osoczu wynoszącego 0,29 μmol/l pozwalają na predykcję poszerzenia aorty (≥ 4,5 cm) z czułością wynoszącą 94% i swoistością równą 92%, przy wysokiej dokładności (pole pod krzywą: 0,786; 95% przedział ufności: 0,709–0,863; p &lt; 0,001). Wnioski: Stężenie ADMA w osoczu stanowi parametr diagnostyczny w odniesieniu do poszerzenia aorty wstępującej, który cechuje się wysoką wrażliwością i swoistością, dlatego należy rozważyć stosowanie go w celu ustalania klinicznego rozpo­znania poszerzenia aorty.

The role of three dimensional transesophageal echocardiography novel-score in the success of redo percutaneous balloon mitral valvuloplasty

Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7–9) and novel 3D TEE score was found 4 (IQR 3–4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS