Influence of Atrioventricular Nodal Reentrant Tachycardia Ablation on Right to Left Inter-atrial Conduction

Background: Radiofrequency (RF) catheter ablation is the procedure of choice for the potential cure of atrioventricular nodal reentrant tachycardia (AVNRT) with high success rates. We hypothesed that as a result of the close proximity of Koch’s triangle and low inter-atrial septal fibers, the RF ablation applied at this region may result in prolongation of inter-atrial conduction time (IACT). Methods: RF ablation of AVNRT was performed by conventional technique. IACT was measured before and 20 minutes after RF ablation during sinus rhythm. Number of ablations given and duration of ablation were noted. Results: The study group was consisted of 48 patients (36 [75%] female, 12 [25%] male, mean age 43.4 ± 14. 5 years). RF ablation was successful in all patients. Mean RF time was 4. 0 ± 3. 3 minutes and mean number of RF was 11. 9 ± 9, 8. The mean IACT was 70.1 ± 9.0 ms before ablation and 84.9 ± 12.7 ms after ablation, which demonstrated a significant prolongation (p<0.001). The prolongation of IACT was very well correlated with the number of (r=0.897, p<0.001) and duration of RF (r=0.779; p<0.001). Conclusions: RF ablation of AVNRT results in prolongation of IACT. The degree of prolongation is associated with the duration and number of RF ablations given. The relationship between this conduction delay and late arrhythmogenesis need to be evaluated

Short and long term outcomes of primary angioplasty in patients aged 75 years and over

The treatment of elderly patients with ST segment elevated myocardial infarction (STEMI) remains controversial. This study aimed to investigate the effects of primary angioplasty in elderly patients on in-hospital and long term major adverse cardiac events (MACE).Materials and methods: From October 2003 to March 2008, we retrospectively enrolled 220 patients aged 75 years and over with STEMI who underwent primary angioplasty. Patients’ characteristics, in-hospital and long term events were recorded.Results: Male/Female ratio of patients was 129/91 and mean age was 78.7 ± 3.6 (range, 75-97) years, and 58.6% of male). Of these patients 29.2% were diabetics, 69.8% were hypertensive, 34.4% were smoker and 43.5% were anemic at admission. Anterior myocardial infarction was diagnosed in 52.3% of patients. Mean pain-balloon time was 222 ± 116 minutes. Eighty two (38.2%) of these 220 patients had three-vessel disease and 12 (5.7%) were diagnosed as cardiogenic shock. Procedural success was observed in 79.6% of patients. Heart failure was observed 27.7% in hospital and intra aortic pump was used in 14.5% of patients. There was no significant difference between age groups in long term major cardiac events and in hospital mortality. Diabetes, leukocyte count at admission and in hospital heart failure were independent predictors of short term MACE and low hemoglobin level at admission and peak CKMB levels were independent predictors of long term MACE.Conclusions: Primary angioplasty in patients aged 75 years and over seems to be associated with low procedural complication, high procedural success, improved short and long term survival

A Fatal Miliary Tuberculosis Case Presenting as Acute Respiratory Distress Syndrome

A case of fatal miliary tuberculosis presenting as acute respiratory distress syndrome (ARDS) was reported. A 15 year old woman, known to have ventricular septal defect for 7 years was admitted to the hospital with fever, shaking chills and dry cough. The chest X-ray revealed miliary pattern throughout both lung fields. The patient developed ARDS within 24 hours of admission to the hospital. Microscopic examination of the endotracheal aspirate of the patient revealed (++) acid fast bacilli. Despite early ventilatory support and antituberculosis therapy the patient died. This case emphasizes the importance of considering miliary tuberculosis as a cause of ARDS

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 outcomes of transcatheter aortic valve implantation with Edwards SAPIEN or CoreValve devices: Single-center experience in Turkey

Background: This study aims to evaluate early- and midterm outcomes of transcatheter aortic valve implantation

Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction

Ozyilmaz, Sinem/0000-0003-4829-8400WOS: 000397951200001PubMed: 28408834Purpose: To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Patients and methods: A total of 234 patients (mean age: 57.2 +/- 11.7 years, 75.2% were males) hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality. Results: Median D-dimer levels were 349.5 (48.0-7,210.0) ng/mL, the average TIMI score was 3.2 +/- 1.2 and the GRACE score was 90.4 +/- 27.6 with high GRACE scores (>118) in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r= 0.215, P= 0.01) and TIMI scores (r= 0.504, P= 0.000). Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio = 18.465, 95% confidence interval: 1.059-322.084, P= 0.046) constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality. Conclusion: Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer assay, GRACE or TIMI scores for predicting the risk of mortality in NSTEMI patients

The evaluation of relationship between neutrophil-to-lymphocyte ratio and slow coronary flow

Objective: The aim of this study was to investigate thecorrelations between leukocyte counts, the neutrophil-tolymphocyteratio (NLR), and slow coronary flow (SCF).Methods: We evaluated 135 patients undergoing coronaryangiography (CAG) within coronary artery disease(CAD) indication. We divided patients into three groupsaccording to the CAG findings. Group 1 consisted of 45patients with an SCF pattern; group 2 consisted of 45 patientswith at least 50% lumen narrowing in at least oneepicardial coronary artery; and group 3 (control group)consisted of 45 patients with normal coronary arteries.The quantification of the coronary flow was assessed usingthe thrombolysis in myocardial infarction (TIMI) framecount method for each of the coronary arteries. Bloodsamples were collected from the patients after a 12 hovernight fasting. The NLR ratio was calculated from theautomated complete blood count.Results: NLR in CAD was higher than in both the SCFand control groups (p=0.008, p<0.001, respectively).However, there was no statistically significant differencebetween SCF and control group (p=0.768). Neutrophilcounts in CAD were higher than in both SCF and controlgroups, but only the difference between CAD and SCFgroups was statistically significant (p=0.010).Conclusion: Our study revealed that circulating neutrophilcounts and NLR were related to the coronary arterydisease, as expected.Key words: Neutrophil-to-lymphocyte ratio, leukocyte subtype, slow coronary flow, coronary artery diseas