Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography

Background: Total white blood cell (WBC) count has been consistently shown to be an independent risk factor and predictor for future cardiovascular outcomes, regardless of disease status in coronary artery disease (CAD). The purpose of this study is to evaluate the relationship between total WBC count and the presence, severity and extent of coronary atherosclerosis detected in subjects undergoing multislice computed tomographic (MSCT) coronary angiography for suspected CAD. Methods: A total of 817 patients were enrolled in this cross-sectional study. Non-significant coronary plaque was defined as lesions causing &#163; 50% luminal narrowing, and significant coronary plaque was defined as lesions causing > 50% luminal narrowing. For each segment, coronary atherosclerotic lesions were categorized as none, calcified, non-calcified and mixed. All images were interpreted immediately after scanning by an experienced radiologist. Results: An association between hypertension, diabetes mellitus, age, gender, hyperlipidemia, smoking, total WBC counts and coronary atherosclerosis was found when patients were grouped into two categories according to the presence of coronary atherosclerosis (p < 0.05). Although plaque morphology was not associated with total WBC counts, the extent of coronary atherosclerosis was increased with higher total WBC quartiles (p = 0.006). Patients with critical luminal stenosis had higher levels of total WBC counts when compared to patients with non-critical luminal narrowing (7,982 &#177; 2,287 vs 7,184 &#177; 1,944, p < 0.05). Conclusions: Our study demonstrated that total WBC counts play an important role in inflammation and are associated with the presence, severity and extent of coronary atherosclerosis detected by MSCT. Further studies are needed to assess the true impact of WBC counts on coronary atherosclerosis, and to promote its use in predicting CAD. (Cardiol J 2011; 18, 4: 371&#8211;377

Dilate Kardiyomiyopati Hastalarında Fragmente Qrs ve Fragmente Geniş Qrs'in Mortalite ve Aritmik Olayları Öngördürücülüğü

Dilated cardiomyopathy patients are at increased risk for ventricular tachyarrythmias an sudden cardiac death (SCD). Ventricular tachycardia and ventricular fibrilation take responsibility of approximately 2/3 of deaths in this patient group. Implantable cardioverter defibrillator (ICD) implantation is proven to be the most effective therapy in preventing SCD. İt is widely accepted that left ventricular ejection fraction (LVEF) is the most valuable predictor of SCD in this population. But even when a LVEF of 35 % is taken as a cut-off, the incidence of appropriate ICD therapy is relatively low, prompting better risk stratification. This incidence is even lower in patients with nonischemic cardiomyopathy. Fragmented QRS (fQRS) a depolarisation abnormality described as various RSR` patterns with or without Q waves on a 12-lead resting ECG. Based on their duration, they are subclassified into fQRS complexes (QRS duration 120 ms). Various RSR` patterns include an additional R wave (R`) or notching in the nadir of the S wave, or the presence of >1 R` (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory. Several studies mostly conducted with ischemic cardimoyopathy patients showed inconsistent results about the value of QRS fragmentation in predicting appropriate ICD therapy and mortality incidence in patients with DCMP. The aim of this study was to evaluate the prognostic value of QRS fragmentation in nonischemic cardimyopathy patients who receive ICD?s for primary prophylaxis. 172 (121 male, mean age 57,30±13,57) consecutive nonischemic dilated cadiomyopathy (NIDCMP) patients who received ICD?s for primary prevention of SCD were retrospectively evaluated. 96 patients (55,6%) did not have fragmentation on their resting ECG. 55 (31,9%), 22 (12,7%) and 3 (1,7%) patients had QRS fragmentation on 1, 2, and 3 terriotires respectively. 114 (66,3%) patients had QRS fragmentation on 2 predicted appropriate ICD therapy with sensitivity of 50 % and specifity of 76 %. Multivariate Cox regression analysis revealed that presence of QRS fragmentation in 2 ECG territories and 3 ECG territories were independent predictors of appropriate ICD therapy with hazard ratios of 5.641 (p=0.001) and 10.290 (p=0.002) respectively. Presence of QRS fragmentation in ?3 leads was independent predictor of appropriate ICD therapy, all cause mortality and combined end point with hazard ratios of 2.767 (p=0.001), 3.725 (p=0.02) and 2.757 (p=0.001) respectively. Kaplan-Meier survival analysis revealed that survival reduced as the number of territories with QRS fragmentation increased and that patients with ?3 leads with QRS fragmentation had reduced survival (p<0.05). As a conclusion, presence and extencity of QRS fragmentation on surface ECG predicted appropriate ICD therapy and all cause mortality in primary prevention DCMP patients.Dilate kardiyomiyopati (DKMP) hastalarında ventriküler aritmiler ve ani kardiyak ölüm sık görülür. Ventriküler taşikardi ve ventriküler fibrilasyon gibi malign aritmiler ani kardiyak ölümlerin (AKÖ) yaklaşık üçte ikisinden sorumludur. Bu hastalarda, aritmiye bağlı ölümleri önlemede en etkili tedavinin implante edilebilen kardiyovertör defibrilatör (ICD) implantasyonu olduğu bilinmektedir. Günümüzde DKMP hastalarında AKÖ'yü öngörmede en etkili parametrenin sol ventrikül ejeksiyon fraksiyonu (LVEF) olduğu bilinmektedir. Ancak LVEF için %35 gibi bir sınır alındığında bile uygun ICD tedavisi alan hastaların oranı göreceli olarak düşüktür. Bu durum iskemik olmayan DKMP'si olan hastalarda daha belirgindir. Bu nedenle, bu hasta grubunda daha etkili bir risk sınıflaması yapılmasında yardımcı olacak parametrelere ihtiyaç vardır. Fragmente QRS (fQRS), majör bir koroner arterin besleme bölgesine uyan 2 ardışık derivasyonda ek bir R dalgasının varlığı (R') veya R veya S dalgasının ucunda çentiklenme varlığı veya birden fazla R' varlığı şeklinde tanımlanan yeni bir depolarizasyon bozukluğudur. Çoğunlukla iskemik DKMP hastalarının incelendiği değişik çalışmalarda fQRS'in uygun ICD tedavisi ve mortaliteyi öngördürücülüğü ile ilgili çelişkili veriler vardır. Bu çalışmanın amacı ICD takılmadan önce çekilen 12 derivasyonlu EKG'de fQRS saptanmasının ve fQRS saptanan derivasyonların yaygınlığının birincil koruma için ICD implante edilen iskemik olmayan DKMP hastalarında uygun ICD tedavisi ihtiyacı ve mortaliteyi öngörüp öngörmediğini araştırmaktır. Çalışmaya birincil koruma için ICD implante edilen 172 iskemik olmayan DKMP hastası (121 erkek, 51 kadın; ortalama yaşları 57,30±13,57) alınmıştır. Hastaların 96'sının (%55,6) EKG'lerinde QRS fragmentasyonu içeren bölge izlenmezken, 55 (%31,9), 22 (%12,7) ve 3 (%1,7) hastanın EKG'sinde sırasıyla 1, 2 ve 3 bölgede fragmentasyon saptanmıştır. 114 (%66,3) hastanın EKG'sinde <3 bölgede fragmentasyon varken, 58 (%33,7) hastanın EKG'sinde ?3 derivasyonda QRS fragmentasyonu saptanmıştır. Ortanca 23 aylık bir izlem boyunca 42 hasta (%24.4) ventriküler taşiaritmi için ICD tedavisi almıştır, 14 hasta (%8.1) herhangi bir nedene bağlı ölmüştür, 49 (% 28.4)hasta ise bu ikisinden oluşan sonlanım noktasına ulaşmıştır. En az bir bölgede fQRS veya f-wQRS'i olan hastalar, QRS fragmentasyonu olmayan hastalara göre ICD tedavisi gerektiren ventriküler taşiaritmi (%33'e karşı %17, p<0.05), tüm nedenlere bağlı mortalite (%11.5'e karşı %11.5, p<0.05), ve ikisinden oluşan birleşik sonlanımın (%37.1'e karşı %17.1, p<0.05) daha sık ortaya çıktığı gözlendi. Hastalar QRS fragmentasyonu olan bölge sayısına göre sınıflandırıldıklarında her üç sonlanım sıklığının QRS fragmentasyonu olan bölge sayısı arttıkça arttığı göze çarpmaktadır (p<0.05). EKG'sinde ?3 derivasyonda QRS fragmentasyonu olan hastaların da <3 derivasyonda QRS fragmentasyonu olan hastalara göre daha sık uygun ICD tedavisi aldıkları (% 27.1'e karşı % 5.9, p<0.05), herhangi bir nedene bağlı öldükleri (%15.5'e karşı %4.4, p<0.05), ve bu ikisinden oluşan birleşik sonlanıma daha sık ulaştıkları (%41.3'e karşı %25.3, p<0.05) saptanmıştır. ROC analizinde QRS fragmentasyonu olan derivasyon sayısı 2'den büyük alındığında ICD tedavisi gerektiren ventriküler taşiaritmi riskini % 50.00 duyarlılık ve % 75.54 özgüllükle öngörmektedir. Çok değişkenli regresyon analizinde 2 bölgede QRS fragmentasyonu olması ICD tedavisi gerektiren ventriküler taşiaritmi riskini 5.641 kat (p=0.001), 3 bölgede QRS fragmentasyonu varlığı ise ICD tedavisi gerektiren ventriküler taşiaritmi riskini 10.290 kat (p=0.002) arttırdığı saptanmıştır. ?3 derivasyonda QRS fragmentasyonu varlığı ise, ICD tedavisi gerektiren ventriküler taşiaritmi riskini 2,767 kat (p=0.001), herhangi bir nedene bağlı mortalite riskini 3.725 kat (p=0.02), birleşik sonlanıma ulaşma riskini ise 2.757 kat (p=0.001) artırmaktadır. Kaplan-Meier analizi ile QRS fragmentasyonu içeren bölge sayısı arttıkça veya ?3 derivasyonda QRS fragmentasyonu varlığında her üç sonlanım için olaysız sağkalım süresinin kısaldığı ve bu etkinin özellikle ICD tedavisi gerektiren ventriküler taşiaritmi için belirgin olduğu saptandı (p<0.05). Sonuç olarak birincil koruma için ICD takılan iskemik olmayan DKMP hastalarında yüzey EKG'de QRS fragmentasyonu varlığı ve yaygınlığı ventriküler taşiaritmi ve tüm nedenlere bağlı mortalite riskini öngördürmektedir

Effect Of Age And Plaque Morphology On Diagnostic Accuracy Of Dual Source Multidetector Computed Tomography Coronary Angiography

Background Multidetector computed tomography (MDCT) coronary angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. The purpose of this study is to investigate the effect of age and coronary plaque calcification on diagnostic accuracy of MDCT. Methods The patients were examined by using dual-source MDCT and conventional coronary angiography. MDCT results were analyzed with regard to the severity (> 50% stenosis) and morphology (non-calcified, mixed, or calcified) of coronary atherosclerotic plaques evaluated in a 16-segment model. Results In total, 181 patients (94 men and 87 women) with 2,687 coronary artery segments were examined with MDCT. Ninety three patients were older than 65 years of age (group A, 42 men) and 88 were younger (group B, 52 men). Two-hundred nine coronary artery segments (7.2%) were excluded because of small distal coronary vessel segments and/or motion artifacts. The overall number of segments with non-diagnostic image quality was similar in both groups of patients. Of the 2,687 evaluated segments, 157 (5.8%) were significantly diseased, and 144 of them were correctly detected by MDCT. Diagnostic evaluation showed that the sensitivity, positive predictive value, specificity, and negative predictive value were 89.5%, 62.5%, 96.0%, and 99.2%, respectively in group A, and 95.2%, 64.8%, 97.5%, and 99.8% in group B, respectively. In addition, detailed segment-based analyses in coronary segments with non-calcified, mixed and calcified plaques in both groups were similar diagnostic accuracy. Conclusions Very high diagnostic accuracy observed in this study suggests that MDCT coronary angiography could be a suitable diagnostic tool for not only younger patients but also for older patients.PubMe

Total White Blood Cell Count Is Associated With The Presence, Severity And Extent Of Coronary Atherosclerosis Detected By Dual-Source Multislice Computed Tomographic Coronary Angiography

Background: Total white blood cell (WBC) count has been consistently shown to be an independent risk factor and predictor for future cardiovascular outcomes, regardless of disease status in coronary artery disease (CAD). The purpose of this study is to evaluate the relationship between total WBC count and the presence, severity and extent of coronary atherosclerosis detected in subjects undergoing multislice computed tomographic (MSCT) coronary angiography for suspected CAD. Methods: A total of 817 patients were enrolled in this cross-sectional study. Non-significant coronary plaque was defined as lesions causing 50% luminal narrowing. For each segment, coronary atherosclerotic lesions were categorized as none, calcified, non-calcified and mixed. All images were interpreted immediately after scanning by an experienced radiologist. Results: An association between hypertension, diabetes mellitus, age, gender, hyperlipidemia, smoking, total WBC counts and coronary atherosclerosis was found when patients were grouped into two categories according to the presence of coronary atherosclerosis (p < 0.05). Although plaque morphology was not associated with total WBC counts, the extent of coronary atherosclerosis was increased with higher total WBC quartiles (p = 0.006). Patients with critical luminal stenosis had higher levels of total WBC counts when compared to patients with non-critical luminal narrowing (7,982 +/- 2,287 vs 7,184 +/- 1,944, p < 0.05). Conclusions: Our study demonstrated that total WBC counts play an important role in inflammation and are associated with the presence, severity and extent of coronary atherosclerosis detected by MSCT. Further studies are needed to assess the true impact of WBC counts on coronary atherosclerosis, and to promote its use in predicting CAD. (Cardiol J 2011; 18,4: 371-377)Wo