Coronary arterial anomalies in a large group of patients undergoing coronary angiography in southeast Turkey

Background: The prevalence of coronary artery anomalies (CAA) are reportedbetween 0.6–1.3% in the literature. CAA are usually asymptomatic incidental findings, but they may deteriorate coronary circulation, cause symptoms andlead to sudden cardiac death; especially in young athletes. Since interventionalprocedures are increasing rapidly for treatment of coronary artery disease (CAD) inthe modern era, comprehensive understanding of CAA is becoming progressively critical element in dealing with CAD.Materials and methods: We reviewed the database of the Cardiac Catheterisation Laboratory of Sani Konukoglu University Hospital in Gaziantep, Turkey. All patientswho were subjected to coronary angiography from 1998 to 2006 were included.Results: Among 53,655 coronary angiographies performed, CAA were foundin 653 patients (incidence of 1.21%); 590 (90.3%) patients had anomalies oforigin and distribution and 63 (11.7%) had coronary fistulae. Separate origins ofleft anterior descending (LAD) and left circumflex (LCX) coronary artery from theleft sinus of Valsalva was the most common anomaly (64.1%). Coronary arteriesbranching from anomalous aortic origin was the second most common anomaly(16.5%). Right coronary artery (RCA) originating from left sinus of Valsalva or leftmain coronary artery (LMCA) was observed in 55 (8.4%) patients, LCX arising fromRCA or right sinus of Valsalva (RSV) was seen in 52 (7.9%) patients and LMCA orLAD originating from RSV was seen in 14 (0.2%) patients. There were 16 (2.45%) patients with single coronary artery and 1 (0.15%) patient with LMCA originating from pulmonary artery.Conclusions: The incidence and the pattern of CAA in our patient population were similar with previous studies. Angiographic recognition of these vessels is importantbecause of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery

Coronary accordion effect mimicking coronary dissection

The coronary "accordion" effect is a rare pseudo-complication of percutaneous coronary intervention (PCI). It is usually observed due to straightening and shortening of tortuous vessels with stiff guidewires during PCI. In this case report, we present an interesting case of the coronary accordion effect observed in a 52-year-old woman undergoing PCI

The relationship between microalbuminuria and isolated coronary artery ectasia

PubMedID: 24943979AIM: Coronary artery ectasia (CAE), is at least 1.5 fold dilatation of at least one coronary segment due to congenital or acquired causes. In this study, we aim to investigate the relation of CAE with microalbuminuria, which is a marker of endothelial dysfunction shown to be associated with increased cardiovascular mortality and morbidity. PATIENTS AND METHODS: Patients with CAE detected during routine coronary angiogram (CAG) and individuals with normal CAG findings have been included in our study. Urine albumin levels were measured by immunoturbidimetric method from samples collected in the morning. Patients with an albumin/creatinine (A/C) ratio less than 0.03 were normal and the ones between values 0.03-0.3 were considered to be microalbuminuric. Patients whose A/C ratios > 0.3 had macroalbuminuria and were excluded. RESULTS: A total of 105 patients (60 with CAE and 45 with normal CAG) were included in the study. Serum creatinine, low-density lipoprotein cholesterol and homocysteine levels were increased in the CAE group. Urine A/C ratio was 0.036 ± 0.040 in the CAE group and 0.018 ± 0.013 in the controls; the difference was statistically significant (p = 0.002). CONCLUSIONS: Blood homocysteine levels and urinary albumin levels are significantly increased in patients with CAE when compared to individuals with normal CAG. Microalbuminuria and hyperhomocysteinemia, two markers of endothelial dysfunction might be associated with pathophysiologic processes leading to CAE

Coronary arterial anomalies in a large group of patients undergoing coronary angiography in southeast Turkey

PubMedID: 23740498Background: The prevalence of coronary artery anomalies (CAA) are reported between 0.6-1.3% in the literature. CAA are usually asymptomatic incidental findings, but they may deteriorate coronary circulation, cause symptoms and lead to sudden cardiac death; especially in young athletes. Since interventional procedures are increasing rapidly for treatment of coronary artery disease (CAD) in the modern era, comprehensive understanding of CAA is becoming progressively critical element in dealing with CAD. Materials and methods: We reviewed the database of the Cardiac Catheterisation Laboratory of Sani Konukoglu University Hospital in Gaziantep, Turkey. All patients who were subjected to coronary angiography from 1998 to 2006 were included. Results: Among 53,655 coronary angiographies performed, CAA were found in 653 patients (incidence of 1.21%); 590 (90.3%) patients had anomalies of origin and distribution and 63 (11.7%) had coronary fistulae. Separate origins of left anterior descending (LAD) and left circumflex (LCX) coronary artery from the left sinus of Valsalva was the most common anomaly (64.1%). Coronary arteries branching from anomalous aortic origin was the second most common anomaly (16.5%). Right coronary artery (RCA) originating from left sinus of Valsalva or left main coronary artery (LMCA) was observed in 55 (8.4%) patients, LCX arising from RCA or right sinus of Valsalva (RSV) was seen in 52 (7.9%) patients and LMCA or LAD originating from RSV was seen in 14 (0.2%) patients. There were 16 (2.45%) patients with single coronary artery and 1 (0.15%) patient with LMCA originating from pulmonary artery. Conclusions: The incidence and the pattern of CAA in our patient population were similar with previous studies. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery. Copyright © 2013 Via Medica

Atypical form of left ventricular noncompaction resembling mass appearance in papillary muscles

PubMedID: 23912970[No abstract available

The relationship between neutrophil/lymphocyte ratio and the TIMI flow grade in patients with STEMI undergoing primary PCI

PubMedID: 23893185OBJECTIVES: ST segment elevation myocardial infarction (STEMI) is an important cause of the morbidity and mortality in coronary artery disease. The aim of this study is to investigate the relationship between hematologic parameters and post primary PCI coronary no-reflow. PATIENTS AND METHODS: A total of 145 consecutive STEMI patients (mean age=58.2±12.3 years) and healthy volunteer admitted within 6 hours from symptom onset were enrolled to the study in the cardiology clinics. The STEMI patients were divided into 2 groups based on the Thrombolysis In Myocardial Infarction (TIMI) flow grade. No-reflow was defined as post-PCI TIMI Flow Grade 0, 1 or 2 and angiographic success was defined as TIMI Grade 3 Flow. Results: Diabetes mellitus hypertension and smoking status were similar between groups.With respect to baseline laboratory status, fasting glucose, blood urea nitrogen, creatinine levels were not significantly different between groups. The neutrophil/ lymphocyte (N/L) ratio was also significantly higher in STEMI group (7.1±4.6 vs. 2.3±1.7, p 0.001). Conclusions: The N/L ratio, which is cheaply and easily measurable laboratory data is independently associated with post primary PCI coronary no-reflow

Relationship of platelet indices with acute stent thrombosis in patients with acute coronary syndrome

Introduction: Despite major advances in stent technology and antithrombotic therapy, the development of stent thrombosis continues to be a major problem in patients who have undergone percutaneous coronary intervention (PCI). Although a few studies have investigated the relationship between early stent thrombosis and platelet activity, the relationship between acute stent thrombosis (AST) (within the first 24 h) and platelet indices is unclear. Aim: We investigated the relationship between AST development and platelet indices in acute coronary syndrome patients. Material and methods: In our case-control study, 33 patients who underwent PCI with subsequent AST development and 59 patients without AST were selected by propensity analysis. We compared the clinical, angiographic, and laboratory data between the AST and control groups. Results: Mean platelet volume (MPV) (p = 0.002) and platelet distribution width (p = 0.014) were significantly higher and platelet count (p = 0.017) was significantly lower in the AST group. Logistic regression analyses showed that MPV was a significant independent predictor of AST (OR = 1.67; 95% CI: 1.11-2.51; p = 0.013). In the ROC analyses, the cut-off value of MPV to detect AST was > 9.1 fl with a sensitivity of 90.9%, a specificity of 42.4%, a positive predictive value of 46.9% and a negative predictive value of 89.3% (AUC: 0.687, 95% CI: 0.582-0.780, p = 0.001). Conclusions: Our study shows that baseline MPV predicts the development of AST in patients with ACS. Mean platelet volume therefore might be an easily accessible marker in the identification of patients at high risk for the development of AST

Association among tenascin-C and NT-proBNP levels and arrhythmia prevalence in heart failure

PubMedID: 29256387Purpose: Tenascin-C (TN-C) and amino-terminal fragment of the B-type natriuretic peptide (NT-proBNP) are the important predictors in prognosis of heart failure (HF). The aim of this study was to analyze the relationship of TN-C and NT-proBNP levels with the frequency and severity of ventricular arrhythmia. Materials and Methods: Our study included 107 HF patients with EF < 45%. According to Holter analysis, the patients were divided into two groups as malignant arrhythmia group (n=29) with Lown Class 4a and 4b arrhythmia and benign arrhythmia group(n=78) with Lown Class 0-3b arrhythmia. The groups were compared with respect to levels of TN-C and NT-proBNP. The relationship of TN-C and NT-proBNP levels with frequency of ventricular premature beat (VPB) was also analyzed. Findings: NT-proBNP (5042.1±1626 versus 1417.1±1711.6 pg/ml) and TN-C (1089±348.6 versus 758.5±423.9 ng/ml) levels were significantly higher in the malignant arrhythmia group than that of the benign arrhythmia group (p<0.001). A significantly strong positive correlation (r=0.741, p<0.001) was found between the NT-proBNP levels and VPB numbers of the patients, whereas a significantly weak positive correlation was detected between the TN-C levels and VPB numbers of the patients (r=0.347, p<0.001). Conclusion: This study has shown that NT-proBNP and TN-C levels increase in the HF patients with malignant arrhythmia. In the HF patients; the frequency of ventricular arrhythmias also increases as NT-proBNP and TN-C levels increase. However, in this study, the old NT-pro BNP seems better than the TN-C. © 2017 CIM

Plasminogen activator inhibitor-1 5G/5G genotype is associated with early spontaneous recanalization of the infarct-related artery in patients presenting with acute ST-elevation myocardial infarction

PubMedID: 23283030BACKGROUND: We aimed to examine the association between plasminogen activator inhibitor-1 (PAI-1) genetic polymorphism and early spontaneous recanalization in patients presenting with acute ST-elevation myocardial infarction. METHODS: Patients admitted to our emergency department with ST-elevation myocardial infarction in the first 6 h of symptom onset were included. An immediate primary percutaneous coronary intervention was performed. Patients were grouped according to the initial patency of the infarct-related artery (IRA) as follows: total occlusion (TO) group [Thrombolysis in Myocardial Infarction (TIMI) 0-1 flow in the IRA], partial recanalization group (TIMI 2 flow in the IRA), and complete recanalization (CR) group (TIMI 3 flow in the IRA). PAI-1 4G/5G polymorphism was detected using the real-time PCR method. RESULTS: There were 107 patients in the TO group, 30 patients in the partial recanalization group, and 45 patients in the CR group. When we evaluated degrees of patency according to the PAI-1 genotype, TO of the IRA was the highest in patients with the PAI 4G/4G genotype (PAI-1 4G/4G: 66.7%, PAI-1 4G/5G: 65.9%, PAI-1 5G/5G: 40.4%) and CR of the IRA was the highest in patients with the PAI 5G/5G genotype (PAI-1 5G/5G: 38.5%, PAI-1 4G/5G: 19.8%, PAI-1 4G/4G: 17.9%). The distribution of genotypes in different degrees of patency of IRA was statistically significant (P=0.029). In logistic regression analysis, the PAI-1 5G/5G genotype was associated independently with the spontaneous CR of the IRA (odds ratio: 2.875, 95% confidence interval [1.059-7.086], P=0.038). CONCLUSION: Patients with the PAI-1 5G/5G genotype seem to be luckier than others in terms of early spontaneous recanalization of the IRA. Further prospective studies with large patient populations are required for more precise results. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio

Background: Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. Methods: 50 patients with symptomatic PAF despite ?1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). Results: In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ± 18.13 ml and 53.24 ± 22.11 ml vs 48.85 ± 12.89 ml and 42.08 ± 13.85 (p = 0.037). LAVi were 20.9 ± 8.91 ml/m2 and 26.85 ± 11.28 ml/m2 vs 25.36 ± 6.21 and 21.87 ± 6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ± 4.09 ng/ml and 6.02 ± 2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ± 1.07 10 3 /µl and 1.98 ± 0.66 10 3 /µl (p = 0.674). Conclusion: LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence. © 2018 Indian Heart Rhythm Societ