Fragmented QRS predicted major adverse cardiovascular events in patients with coronary artery disease and percutaneous coronary intervention, 10-years of follow-up

Aim Identifying high-risk groups in patient with coronary artery disease (CAD) is critical for predicting future adverse events. fQRS has been shown to be related to major cardiovascular adverse events (MACE) in patients with CAD. However, predictive value of fQRS for more than 5 yrs has not been evaluated. This study examined the predictive value of fQRS in patients with CAD and percutaneous coronary intervention during a 10-yrs period. Material and methods Patients with CAD and percutaneous coronary intervention between March 2007 and May 2009 were included the study. An electrocardiogram was recorded following percutaneous coronary intervention and analyzed for the presence of fQRS. The fQRS pattern was defined as an additional spike inside the QRS complexes of at least two consecutive leads. Patients were followed for 10 yrs. A MACE was all-cause mortality or new-onset decompensated heart failure. Patients were divided into two groups according to presence or absence of MACE, and their clinical variables were compared. Results Of 1261 patients included in the study, MACE developed in 374 (29.6%). MACE (+) patients were older (p<0.001), more likely to have diabetes mellitus (p=0.003), fQRS (p<0.001), and ST-elevated myocardial infarction (STEMI) (p<0.001). Multivariable Cox regression analysis revealed that age (p<0.001), STEMI (p=0.001), fQRS (p=0.017), and elevated serum creatinine (p=0.001) were independent predictors of MACE. Conclusion The presence of fQRS predicted MACE during 10 yrs of follow-up of patients with CAD and percutaneous coronary intervention

Hair whitening and obesity are independently related to ascending aorta dilatation in young-middle aged men

OBJECTIVE: Hair whitening (HW) is strongly linked with aging. Ascending aortic dilation (AAD) and HW share common etiologic factors. We investigated the association of HW with ascending aortic diameters. METHODS: Our study included 93 male subjects aged below 50 years. All patients underwent echocardiography to measure ascending aortic diameter, in addition to routine biochemistry tests, physical examination, and thorough medical history. HW score (HWS) was defined according to the percentage of white hair (HWS 1: <25%; HWS 2: 25–50%; HWS 3: 50–75%; and HWS 4: 75–100). RESULTS: Patients with highest HWS were older and had a higher percentage of hypertension (HT) and family history of HW. Moreover, this subgroup had increased ascending aortic diameter, higher serum uric acid, and lower total bilirubin concentrations. Multivariate analyses including age, HT, height, waist circumference, c-reactive protein, and family history of HW identified body weight and HWS as the independent predictors of ascending aortic diameter. CONCLUSION: An independent association between the degree of HW and AAD exists in middle-aged men, which may depend on coexisting factors that enhance both pathologies rather than causality. We think that oxidative stress may be one of these stressors

Homozigot faktör V Leiden mutasyonu olan genç erkek hastada

Genç hastalarda, özellikle erkek cinsiyette, faktör V Leiden mutasyonu ile akut miyokart enfarktüsü arasında ilişki olduğunu bildiren yayınlar vardır. Yirmi sekiz yaşında erkek hasta, yeni başlangıçlı şiddetli göğüs ağrısı yakınmasıyla başvurdu. Hastada, sigara içme ve babasında 45 yaşından sonra geçirilmiş koroner arter hastalığı ve akut miyokart enfarktüsü öyküsü dışında başka önemli risk faktörü yoktu. Elektrokardiyografide V1-5 prekordiyal derivasyonlarda ST-segment yükselmesi izlendi. Kan basıncı, nabız ve diğer klinik parametrelerde anormallik yoktu. Hastaya acil koroner anjiyografi yapıldı. Sol ön inen arterin orta bölümünde önemli daralma ve orta derecede trombüs görüldü; dikkat çekici ateroskleroza ise rastlanmadı. Diğer koroner arterler normal bulundu. Sorumlu lezyon için direkt stent yerleştirme sonrasında sol ön inen arterdeki tıkanıklık giderildi. Periferik kandan alınan DNA örneklerinin polimeraz zincir reaksiyonu yöntemiyle incelenmesi sonucunda hastada homozigot faktör V Leiden mutasyonu saptandı. Taburcu olmadan önce yapılan transtorasik ekokardiyografide anteriyor ve apikal segmentlerde hafif hipokinezi dışında bir sorun gözlenmedi.There are several reports on the association between the factor V Leiden mutation and acute myocardial infarction (AMI) in young patients, in particular young males. A 28-year-old male patient was admitted with severe chest pain of new onset. He was an active smoker. His father had a history of coronary artery disease and AMI after the age of 45 years. There were no other major coronary risk factors. His electrocardiogram showed ST-segment elevation in the precordial leads V1 to V5. His blood pressure, pulse rate, and other clinical parameters were stable. Emergency coronary angiography showed a significant narrowing in the midportion of the left anterior descending (LAD) artery with a moderate intracoronary thrombus, and no or minimal atherosclerosis. The other coronary arteries were normal. Direct stenting was performed for the culprit lesion, which resulted in relief of obstruction and significant improvement in the LAD artery. DNA samples isolated from the peripheral blood were analyzed by polymerase chain reaction and the patient was found to be homozygous for the factor V Leiden mutation. Transthoracic echocardiography before discharge showed only mild hypokinesis of the anterior and apical segments

To determine LDL phenotypes using lipids, lipoproteins, apoproteins, and sdLDL through association rule mining

Objective: The atherogenic lipoprotein phenotype is closely associated with the risk assessment of Coronary Artery Disease (CAD) and the monitoring of treatment processes. Particularly, high levels of small dense low-density lipoprotein (sdLDL) and low levels of large buoy-ant low-density lipoprotein (lbLDL) are critical in determining Pattern B. This study aims to determine the lipid phenotype using the Association Rule Mining (ARM) method, based on concentrations of lipids, lipoproteins, apoproteins, and sdLDL.Materials and Methods: This retrospective case-control study utilized analytical research methods. Numerical variables were expressed as mean, standard deviation, median, and min-max values. Statistically significant differences were observed between the low-density lipoprotein (LDL) size categories in terms of triglycerides (TG), LDL, high-density lipoprotein (HDL), apolipoprotein B (ApoB), apolipoprotein E (ApoE), sdLDL, and lbLDL distributions. ARM was employed to detect the lipoprotein phenotype.Results: Statistically significant differences were found between the LDL size categories in distributions of TG, LDL, HDL, ApoB, ApoE, sdLDL, and lbLDL (p(TG)<0.001, p(LDL)=0.03, p(HDL)<0.001, p(ApoB)=0.016, p(ApoE)=0.004, p(sdLDL)<0.001, and p(lbLDL)<0.001). The ARM method revealed that the probability of phenotype B is 100% for sdLDL values in the range of 15.5-109 and lbLDL values in the range of 0-31.5.Conclusion: This study introduces a contemporary approach for detecting lipoprotein phenotypes using ARM, further substantiating the strong correlation between atherogenic phenotypes and sdLDL

Hastaların koroner anjiyografi hakkındaki bilgi düzeyleri ve beklentileri

Bu çalışmada, hastaların koroner anjiyografi hakkında bilgi düzeylerinin araştırılması amaçlandı. Gereç ve yöntem: Bu anket çalışması Türkiye’nin iki ayrı bölgesinde (Rize ve İstanbul) yapıldı. Elektif koroner anjiyografi (KAG) yapılması için başvuran hastaların koroner anjiyografi hakkında bilgi düzeylerini ölçmek için 7 tanesi açıklamalı, 4 adet de seçenekli, 11 soruluk bir anket formu hazırlandı. Soruların ve yanıtların geçerliliği 10 gönüllü hastada test edildikten sonra anket, ilk defa KAG olacak 150 hastaya (102 erkek, 48 kadın, ortalama yaş 57±9.6 yıl) işlem öncesi uygulandı. Hastaların KAG işleminin nasıl yapıldığı, faydaları ve işlemin komplikasyonları hakkında hastaların bilgileri, beklentileri ve bilgiye ulaşma şekilleri sorgulandı. Bulgular: “Koroner anjiyografiden ne gibi faydalar bekliyorsunuz?” sorusuna %36’si (n=54) “kalp damar hastalığımın anlaşılması, tanı”, %32’si (n=48), “hastalığıma tedavi sağlayacağı, damar açma’’ şeklinde yanıtladı. Koroner anjiyografi girişim öncesinde bu hastalar eğitilmiş sağlık personeli tarafından koroner anjiyografi hakkında bilgilendirildi ve seçenekli anket soruları soruldu. Seçenekli anket sorularına, “koroner anjiyografi işleminden beklentileriniz nedir?”, sorusuna %62’si (n=93), “kalp damarlarında tıkanıklık ya da daralma olduğunun anlaşılması” seçeneğini işaretlemiştir. Seçenekli anket sorularına verilen doğru cevap sayısında ve oranında, açıklamalı anket sorularına verilen yanıta göre anlamlı olarak yüksek saptandı. (p<0.05). Sonuç: Koroner anjiyografi olacak hastaların, yaş ve eğitim düzeyi göz önünde bulundurularak bilgilendirilmesine ve klasik bilgilendirme dışında yöntemlerin uygulanmasına ihtiyaç vardır.The aim of this study was to investigate patient education level on coronary angiography procedure. Material and methods: This survey has been conducted in two different areas of Turkey. A questionnaire was prepared for patients admitted to undergo elective coronary angiography (CAG) consisting of 11 questions which 7 and 4 of those were annotated and multiple choice, respectively. After validation of the questionnaire has been performed with 10 volunteers, questionnaire was applied to patients who undergo CAG for the first time. Patients' knowledge about application, benefits, complications of CAG procedure, patients' expectations and way of the information access have been interrogated. Results: The questionnaire was applied to 150 patients (102 males and 48 females, mean age: 57±9.6 years) who undergo this procedure for the first time. "What kind of benefits you expect from CAG?" was responded as "understanding of my cardiovascular disease and diagnosis" by 36% of responders (n=54) and as "to cure my disease and blood vessel opening" by 32% of responders (n=48). After these patients have been informed by the health staff trained about CAG and they were asked the choice questionnaire. "What do you expect from CAG?" was responded by choosing the answer of "To understand existing of occlusion or narrowing" by 62% of responders (n=93). Rate and number of correct answers were significantly increased in choice questionnaire than annotated questionnaire (p<0.05). Conclusion: It is necessary to inform patients who undergo CAG taking into consideration of their age and educational level

Tek koroner arter:Sağ koroner arterin sol ön inen koroner arterden çıkış anomalisi

48 yaşında bayan hasta, birimimize göğüs ağrısı değerlendirilmesi için gönderildi. Koroner anjiyografisinde, tek koroner arterin oldukça nadir çeşidi olan, sol ön inen koroner arterden ayrılan sağ koroner arterin çıkış anomalisi saptandı. Bu hastada göğüs ağrısı, muhtemelen miyokard iskemisi ile ilişkiliydi. Bu vakada, koroner anjiyo-grafi görüntülerinde saptanan, tek koroner arter: Sağ koroner arterin sol ön inen koroner arterden çıkış anomalisi olgusunu sunmayı amaçladık

Dev üst mezenter arter anevrizması

Üst mezenter arter anevrizması (ÜMA) nadir bir durum olup çoğu semptomatiktir. Giderek artan karın ağrısı, barsak iskemi belirtileri ve yırtılma en sık belirtilerdir. Burada karında rahatsızlık hissi ile başvuran bir hastada saptanan dev üst mezenter arter anevrizması’nı sunuyoruz.Aneurysm of the superior mesenteric artery (SMA) is a rare condition and most of them are symptomatic. Gradually increasing abdominal pain, intestinal ischemic symptoms and rupture are the most common symptoms. We herein report a giant SMA aneurysm detected in a patient with complaint of abdominal discomfort

Partial anomalous pulmonary venous connection. (Left pulmonary vein-left brachiocephalic vein connecting); angiography images

Parsiyel pulmoner venöz dönüş anomalisi, pulmoner venlerin koroner sinüs, sağ atriyum veya direkt olarak süperiyor vena kava içine açıldığı, doğuştan kalp defektidir. Parsiyel pulmoner venöz dönüş anomalisi tedavi edilmezse, ciddi pulmoner damar hastalığı ve sağ ventrikül yetersizliği oluşturabilir. Biz bu vakada, koroner anjiyografi görüntülerinde, parsiyel pulmoner venöz dönüş anomalisi (sol pulmoner ven ile sol brakiyosefalik ven bağlantısı) bulunan hastayı sunmayı amaçladık.Partial anomalous pulmonary venous connection is a congenital defect where pulmonary veins drain into the right atrium, the coronary sinus, or directly to the superior vena cava. If left untreated, partial anomalous pulmonary venous connection may result in severe right ventricular failure and pulmonary vascular disease. İn this case we aimed to present coronary angiography imaging of a patient with partial anomalous pulmonary venous connection. (Left pulmonary vein-left brachiocephalic vein connecting)

Koroner arter hastalığının yaygınlığı ile aortik stiffnes ilişkisi

Amaç: Bu araştırmada, koroner arter hastalığının yaygınlığı ve ciddiyeti ile aortun elastikiyet özellikleri arasındaki ilişki araştırıldı. Yöntem ve gereç: Çalışmaya, koroner arter hastalığı (KAH) şüphesiyle elektif koroner anjiyografi yapılan ardışık yüz hasta alındı. Bunlardan KAH tespit edilen, yaş ortalamaları 62,1 ± 10,3 yıl olan 47 erkek, 16 kadın toplam 63 hasta grup 1 olarak alındı. Koroner arterleri normal ve yaş ortalamaları 51,4 ± 10,8 yıl olan 20 erkek, 17 kadın toplam 37 olgu grup 2 olarak alındı. Koroner anjiyografi sonrası tüm hastalara ekokardiyografi yapılarak aortun elastik özellikleri (aortik distensibilite ve stifness index) ölçüldü. Hastaların yaş, cinsiyet ve ateroskleroz risk faktörleri sorgulandı. Koroner anjiyografi de % 50’den fazla darlık olması ciddi koroner arter hastalığı olarak kabul edildi. Koroner arter hastalığının yaygınlığı gensini skoru ile belirlendi. Bulgular: Grup 1 deki hastaların yaş ortalamaları (62,1 ± 10,3 yıl) ve erkek cinsiyet oranı, grup 2’den (51,4 ± 10,8) daha fazla bulundu (sırasıyla P < 0.001, P = 0.035). Grup 1’in aortik stifnes ortalaması grup 2’ye göre anlamlı derecede artarken (sırasıyla, 8,9 ± 5,1 mm, 6,1 ± 4,6 mm, P = 0.001). aortik distensibilite ortalaması ise anlamlı derecede azalmış bulundu (sırasıyla, 23,4 ± 16,5 mm, 42,4 ± 27,1 mm, P < 0.001). İleri yaş, koroner arter hastalığı risk faktörleri ve koroner arter hastalığının yaygınlığı ile korele olarak aortik stifnes indeks artmakta, distensibilite azalmaktadır. Sonuç: KAH’ın yaygınlığı ve tutulan koroner damar sayısı ile orantılı olarak aortik stifnesi artmakta, distensibilite ise azalmaktadır.Aim: To investigate the relation between aortic stiffness and the extension/severity of coronary artery disease (CAD). Materials and methods: A consecutive 100 patients with suspicion of CAD who underwent elective coronary angiography were enrolled in this study. Of those patients determined as having CAD, 63 were classifi ed as Group I (mean age: 62.1 ± 10.3 years; 47 male and 16 female). Group II included 37 patients with normal coronary arteries (mean age: 51.4 ± 10.8 years; 20 male and 17 female). Aortic flexibility (aortic distensibility and stiffness index) was evaluated by echocardiography aft er coronary angiography in all of the patients. Patient data were gathered in relation to age, sex, and atherosclerotic risk factors. Stenosis above 50% was accepted as severe CAD. The extension of coronary artery disease was determined using the Gensini score. Results: The mean age (62.1 ± 10.3 and 51.4 ± 10.8, respectively) and the male/female rate in Group I were higher than in Group II (P < 0.001 and P = 0.035, respectively). The mean aortic stiffness in Group I was significantly increased compared to Group II (8.9 ± 5.1 mm and 6.1 ± 4.6 mm, respectively; P = 0.001), whereas the mean aortic distensibility in Group I was signifi cantly lower than in Group II (23.4 ± 16.5 mm and 42.4 ± 27.1 mm, respectively; P < 0.001). The aortic stiffness index increased and distensibility decreased in correlation with age, coronary artery risk factors, and extension of CAD. Conclusion: The aortic stiffness index increased and distensibility decreased in correlation with CAD extension and the number of affected coronary arteries

Koroner arter hastalığı risk faktörlerinin dağılımı: bölgesel bir analiz

Amaç: Bu çalışmadaki amacımız, Rize ili ve civarında koroner arter risk faktörlerinin sıklık ve dağılımını incelemektir. Yöntem ve gereç: Bu gözlemsel çalışmaya, 452 hasta (333 erkek, 119 kadın) alındı. Hastaların demografi k özelliklerinin yanı sıra, geleneksel risk faktörleri kaydedildi. Hastalar yaşa, cinsiyete ve elektrokardiyografi k özelliklerine göre gruplara ayrıldı. Bulgular: Çalışmaya katılan hastaların yaş ortalaması 63 ± 13 iken, % 74’ü erkekti. Sigara kullanımı ve HT genç yaşta ve erkeklerde daha fazla görüldü (% 71). Diyabetes mellitusta yaş grupları arasında fark tespit edilmedi. Kadınlarda HDL-C (P < 0,001) ve Total-C/HDL-C oranı (P < 0,05) erkeklere göre daha yüksek bulundu. Sigara kullanımı ve aile hikayesi yaşla birlikte azalma gösterdi. Sonuç: Hastaların % 97’sinde en az bir risk faktörü mevcuttu. Dolayısıyla çalışmamız, en önemli morbidite ve mortalite nedeni olan koroner arter hastalığında, hastalardaki risk faktör değişikliğinin ne kadar önemli olduğunu bizlere tekrar vurgulamaktadır.Aim: To analyze the frequency and distribution of coronary artery risk factors in the city of Rize and its surrounding areas. Materials and methods: Th is observational study included 452 patients (333 men, 119 women). In addition to demographic characteristics of the patients, conventional risk factors were also recorded. Th e patients were grouped according to their ages, gender, and electrocardiographic characteristics. Results: Th e mean age of participants was 63 ± 13 years and 74% were male. Smoking and hypertension (HT) were seen more oft en (71%) in younger male patients. No diff erence among age groups was detected with regard to the occurrence of diabetes mellitus. Th e levels of HDL-cholesterol (P < 0.001) and the ratio of total cholesterol to HDL-cholesterol (P < 0.05) were found to be relatively higher in female patients. Th e prevalence of smoking and familial risk factors both decreased with age. Conclusion: At least one of these risk factors was detected in 97% of patients. Th erefore, our study continues to emphasize the crucial role of modifi cation of risk factors in patients with coronary artery disease, the most important etiologic factor for morbidity and mortality