Comparison of the diagnostic characteristics of electrocardiographic algorithms in detecting the localization of the accessory pathway in Wolff Parkinson White Syndrome

Amaç: Wolff Parkinson White Sendromu’nda aksesuvar yol lokalizasyonunu tespit etmek için kullanılan bazı elektrokardiyografik algo‐ ritmaların (Arruda, Boersma, Fitzpatrick ve Chiang) tanısal özelliklerinin birbirleri ile karşılaştırılması. Gereç ve Yöntem: Çalışmamıza 01.10.2013‐15.10.2017 tarihleri arasında Wolff Parkinson White Sendromu sebebi ile kliniğimize baş‐ vuran ve takibinde elektrofizyolojik çalışma yapılan 50 hasta (yaş ortalaması 34,8 ±14,3 yıl, %52’si erkek) dahil edildi. Tüm hastaların elektrokardiyogramlarında işlem öncesi preeksitasyon paterni mevcuttu. Hastaların elektrofizyolojik çalışma öncesi elektrokardiyogra‐ fileri incelendi ve herbirinde Arruda, Boersma, Fitzpatrick ve Chiang algoritmaları kullanılarak aksesuvar yol lokalizasyonu tahminleri ya‐ pıldı. Daha sonrasında elde edilen veriler ile elektrofizyolojik çalışma sonrasında tespit edilen gerçek aksesuvar yol lokalizasyonları ara‐ sındaki uyum değerlendirildi. İşlem öncesi elektrokardiyografilerine ulaşılamayan hastalar çalışma dışı bırakıldı. Dört algoritma ile elek‐ t ro fizyolojik çalışma arasındaki aksesuvar yol tahminindeki uyum fleiss kappa test istatistiği ile hesaplandı. Bulgular: Elektrofizyolojik çalışma ile doğrulanan aksesuvar yol tahmin etme gücü Arruda algoritması ile %58, Chiang algoritması ile %52, Boersma algoritması ile %48 ve Fitzpatrick algoritması ile %38 olarak tespit edildi. Algoritmaların elektrofizyolojik çalışma ile olan uyumları incelendiğinde Arruda algoritması orta derecede uyum göstermekte idi (Kappa: 0,48, p <0,001). Diğer 3 algoritma ise zayıf de‐ recede uyum göstermekte idi. Sonuç: Aksesuar yol lokalizasyonunu belirlemede elektrofizyolojik çalışma altın standart yöntem olarak bilinmektedir. Söz konusu elek‐ trokardiyografi algoritmalarının aksesuvar yol lokalizasyonunu tahmin etme gücü beklenenden düşük olmasına rağmen bu algoritma‐ ların elektrofizyolojik çalışma öncesi kullanımının işlemin başarı şansını artırabileceğini düşünmekteyiz. Bu çalışmada kullanılan algorit‐ malar arasında en yüksek tahmin gücü Arruda algoritmasında saptandı (%58).Objective: To compare the diagnostic characteristics of some electrocardiographic algorithms (Arruda, Boersma, Fitzpatrick, and Chiang) used to detect accessory pathway localization in Wolff Parkinson White Syndrome. Material and Method: Our study included fifty patients (mean age 34.8±14.3 years, 52% male) who applied to our clinic from 01.10.2013 to 15.10.2017 due to Wolff Parkinson White Syndrome and underwent electrophysiological study. There was a pre‐excita‐ tion pattern in the electrocardiograms of all patients before the procedure. The electrocardiograms of the patients were examined be‐ fore the electrophysiological study, and accessory pathway localization estimations were made using the Arruda, Boersma, Fitzpatrick, and Chiang algorithms for each. The compatibility between the data obtained afterwards and the actual accessory pathway localiza‐ tions detected after electrophysiological study was evaluated. Patients whose electrocardiograms could not be accessed before the pro‐ cedure were excluded from the study. The agreement between the four algorithms and the electrophysiological study in the prediction of the accessory pathway was calculated using the Fleiss’ kappa test statistics. Results: Accessory pathway prediction power verified by electrophysiological study was determined as 58% by Arruda’s algorithm, 52% by Chiang’s algorithm, 48% by Boersma’s algorithm and 38% by Fitzpatrick’s algorithm. Upon review of the agreement of the algorithms with the electrophysiological study, the Arruda’s algorithm showed moderate agreement (Kappa: 0.48, p<0.001). The other 3 algorithms showed weak level of agreement. Conclusion: Electrophysiological study is known as the gold standard method for detecting accessory pathway localization. Although the power of these electrocardiogram algorithms to predict accessory pathway localization is lower than expected, we believe that the use of these algorithms before electrophysiological study may increase the chance of success of the procedure. Among the algorithms used in this study, the highest predictive power was found in the Arruda algorithm (58%)

Is routine echocardiography necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia?

Background: The aim of this study was to investigate whether pericardial effusion (PE) detected by transthoracic echocardiography (TTE) was clinically significant and whether routine echocardiography was necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). Methods: A total of 202 patients with AVNRT were included in the study from three centers. The patients received basic electrophysiology-guided therapy, followed by radiofrequency ablation (RFA). All patients underwent TTE before and after RFA therapy. Results: The mean age of the study population was 46.2 &#177; 17.9 and 30.7% of the patients were male. Of these patients, six (3%) had postoperative PE, as detected by TTE. However, none of them had cardiac tamponade (CT). Four patients had minimal PE, while two had mild PE. Repeated TTE at one to three months showed resolved PE. No significant difference was seen among the patients with and/or without PE in terms of age, gender, the number of RFA applications, or RFA duration; however, significantly prolonged duration of fluoroscopy exposure was observed in the patients with PE. Conclusions: PE was detected in 3% of the patients by TTE and associated with prolonged duration of fluoroscopy exposure. However, no patients with moderate or large PE or cardiac tamponade were found in the study. In conclusion, we suggest that TTE should only be performed in the presence of clinical indications following ablation of AVNRT

Increased mean platelet volume associated with extent of slow coronary flow

Background: Slow coronary flow (SCF) is characterized by delayed opacification of epicardial coronary vessels. SCF can cause ischemia and sudden cardiac death. We investigated the association between presence and extent of SCF, and cardiovascular risk factors and hematologic indices. Methods: In this study, 2467 patients who received coronary angiography for suspected or known ischemic heart disease were retrospectively evaluated between April 2009 and November 2010. Following the application of exclusion criteria, our study population consisted of 57 SCF patients (experimental group) and 90 patients with age- and gender-matched subjects who proved to have normal coronary angiograms (control group). Baseline hematologic indices were measured by the automated complete blood count (CBC) analysis. The groups were evaluated for cardiovascular risk factors and medications. Patients were categorized based on the angiographic findings of vessels with or without SCF. Moreover, patients with SCF were divided into subgroups relative to the extent of SCF. Results: Among the 147 patients (mean age 52.7 &#177; 10.0, 53.7% male), mean platelet volume (MPV) ranged from 6.5 fL to 11.7 fL (median 7.9 fL, mean 8.1 &#177; 0.8 fL). Diabetes (OR = 3.64, 95% CI 1.15&#8211;10.43, p = 0.03), hypercholesterolemia (OR = 4.94, 95% CI 1.99&#8211;12.21, p = 0.001), smoking (OR = 3.54, 95% CI 1.43&#8211;8.72, p = 0.006), hemoglobin (OR = 1.69, 95% CI 1.22&#8211;2.36, p = 0.002), and MPV (OR = 2.52, 95% CI 1.43&#8211;4.44, p = 0.001) were found to be the independent correlates of SCF presence. Only MPV (OR = 2.13, 95% CI 1.05&#8211;4.33, p = 0.03) was identified as an independent correlate of extent of SCF. Conclusions: Elevated baseline MPV value was found to be an independent predictor of the presence and extent of SCF

Coronary lesion complexity assessed by SYNTAX score in 256-slice dual-source MDCT angiography

PURPOSE:The SYNTAX Score (SS) has an important role in grading the complexity of coronary artery disease (CAD) in patients undergoing revascularization. Noninvasive determination of SS prior to invasive coronary angiography (ICA) might optimize patient management. We aimed to evaluate the agreement between ICA and multidetector computed tomography (MDCT) while testing the diagnostic effectiveness of SS-MDCT.METHODS:Our study included 108 consecutive patients who underwent both MDCT angiography with a 256-slice dual-source MDCT system and ICA within 14±3 days. SS was calculated for both ICA and MDCT coronary angiography. Spearman’s rank correlation coefficient was used to evaluate the association of SS-MDCT with SS-ICA, and Bland-Altman analysis was performed.RESULTS:The degree of agreement between SS-ICA and SS-MDCT was moderate. The mean SS-MDCT was 14.5, whereas the mean SS-ICA was 15.9. After dividing SS into three groups (high [≥33], intermediate [23–32], and low [≤22] subgroups), agreement analysis was repeated. There was a significant correlation between SS-MDCT and SS-ICA in the low SS group (r=0.63, P = 0.043) but no significant correlation in the high SS group (r=0.036, P = 0.677). The inter-test agreement analysis showed at least moderate agreement, whereas thrombotic lesions and the type of bifurcation lesion showed fair agreement.CONCLUSION:The calculation of SS-MDCT by adapting SS-ICA parameters achieved nearly the same degree of precision as SS-ICA and was better than SS-ICA, especially in the low SS group

İki boyutlu strain görüntüleme: Temel esaslar ve teknik özellikler

Doku Doppler görüntüleme (TDI) ve TDI kaynaklı strain bölgesel miyokardial fonksiyonların non-invasiv değerlendirmesinde oldukça doğru bilgiler vermektedir. Yüksek temporal ve spatial çözünürlüğü nedeniyle, kardiyak siklusun her fazında bölgesel miyokardiyal fonksiyonların değerlendirmesine imkan tanır. Ancak, bu metodun en önemli kısıtlılığı açı bağımlı olmasıdır. Speckle tracking echocardiography gibi miyokardiyal deformasyonu ölçen yeni teknikler, TDI kaynaklı strainin açı bağımlılığı limitasyonunun üstesinden gelebilmektedir. Üstelik miyokardial fiber orientasyonunu ile ilgili daha değerli bilgiler vermektedir. Bu derleme miyokardiyal mimari ve fonksiyonları ve STE için temel oluşturacak bu bilgilerin teknik olarak gözden geçirilmesini içermektedir.Tissue Doppler Imaging (TDI) and TDI-derived strain provide considerably accurate information in the non-invasive assessment of local myocardial functions. Given its high temporal and spatial resolution, TDI allows assessment of local myocardial functions in each phase of cardiac cycle. However, the most important limitation of this method is its angle dependence. New techniques to measure myocardial deformation, such as speckle tracking echocardiography, overcome the angle-dependence limitation of TDI-derived strain. Moreover, these techniques provide more unique information about myocardial fiber orientation. This review examines the architectural structure and function of the myocardium and includes technical revisions of this information that will provide a basis for STE

Thrombus aspiration in patients with ST elevation myocardial infarction : meta-analysis of 16 randomized trials

Objective: The mortality rate is high in some patients undergoing primary percutaneous coronary intervention (PPCI) because of ineffective epicardial and myocardial perfusion. The use of thrombus aspiration (TA) might be beneficial in this group but there is contradictory evidence in current trials. Therefore, using PRISMA statement, we performed a meta-analysis that compares PPCI+TA with PPCI alone. Methods: Sixteen studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed, were included in this meta-analysis. We calculated the risk ratio (RR) for epicardial and myocardial perfusion, such as the Thrombolysis In myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke. Results: Postprocedural TIMI-III flow frequency, postprocedural MBG II-III flow frequency, and postprocedural STR were significantly high in TA+PPCI compared with the PPCI alone group. However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95% confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%, RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028, 95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI: 0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI: 0.588-1.959, p=0.819) rates were comparable between the groups. Conclusion: This meta-analysis is the first updated analysis after publishing the 1-year result of the “Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction” trial, and it showed that TA did not reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke. (Anatol J Cardiol 2015; 15: 175-87)Objective: The mortality rate is high in some patients undergoing primary percutaneous coronary intervention (PPCI) because of ineffective epicardial and myocardial perfusion. The use of thrombus aspiration (TA) might be beneficial in this group but there is contradictory evidence in current trials. Therefore, using PRISMA statement, we performed a meta-analysis that compares PPCI+TA with PPCI alone. Methods: Sixteen studies in which PPCI (n=5262) versus PPCI+TA (n=5256) were performed, were included in this meta-analysis. We calculated the risk ratio (RR) for epicardial and myocardial perfusion, such as the Thrombolysis In myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and stent thrombosis (ST) resolution (STR), and clinical outcomes, such as all-cause death, recurrent infarction (Re-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), stent thrombosis (ST), and stroke. Results: Postprocedural TIMI-III flow frequency, postprocedural MBG II-III flow frequency, and postprocedural STR were significantly high in TA+PPCI compared with the PPCI alone group. However, neither all-cause mortality [6.6% vs. 7.4%, RR=0.903, 95% confidence interval (CI): 0.785-1.038, p=0.149] nor Re-MI (2.3% vs. 2.6%, RR=0.884, 95% CI: 0.693-1.127, p=0.319), TVR/TLR (8.2% vs. 8.0%, RR=1.028, 95% CI: 0.900-1.174, p=0.687), ST (0.93% vs. 0.90%, RR=1.029, 95% CI: 0.668-1.583, p=0.898), and stroke (0.5% vs. 0.5%, RR=1.073, 95% CI: 0.588-1.959, p=0.819) rates were comparable between the groups. Conclusion: This meta-analysis is the first updated analysis after publishing the 1-year result of the “Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction” trial, and it showed that TA did not reduce the rate of all-cause mortality, Re-MI, TVR/TLR, ST, and stroke. (Anatol J Cardiol 2015; 15: 175-87

Koroner baypas cerrahisi ve çıplak metal stent uygulanan hastaların klinik sonlanımlarının karşılaştırılması

Giriş: Biz bu çalışmamızda, koroner baypas greftleme cerrahisi ile çıplak metal stent uygulanmış hastalarda SYNTAX (Sx) skoru ile değerlendirilen koroner lezyon kompleksitelerinin klinik sonlanımlar üzerine etkisini incelemeyi amaçladık.Hastalar ve Yöntem: Çalışma grubumuz çıplak metal stent uygulanmış (n= 265) ve koroner baypas cerrahisine giden (n= 294) 459 hastadan oluşmaktadır. Koroner arter hastalığı kompleksitesi Sx skoru ile değerlendirilmiştir. Sx skoru, hafi f Sx skoru (= 33) olmak üzere üç gruba ayrılmıştır.Bulgular: Çalışma süresince orta dönem takipte herhangi bir nedenle revaskülarizasyon sıklığı hem tüm grupta hem de Sx alt gruplarında perkütan koroner girişim uygulanan hastalarda koroner baypas cerrahisine giden hastalara göre daha fazladır. Orta dönem takipte herhangi bir nedenden ölüm sıklığı düşük ve orta Sx gruplarında tedavi grupları arasında benzer bulunmuştur. Ancak yüksek Sx skoru grubunda orta dönem takipte herhangi bir nedenden ölüm sıklığı perkütan koroner girişim uygulanan hastalarda koroner baypas cerrahisine giden hastalara göre daha fazladır. Tüm popülasyonda herhangi bir nedenden dolayı ölüm için düzeltilmiş risk perkütan koroner girişim ve koroner baypas cerrahisi arasında benzerken [hazard ratio, %95 GA: 0.88 (0.38-2.05), p= 0.780], herhangi bir nedenle revaskülarizasyon için düzeltilmiş risk koroner baypas cerrahisi grubuna göre perkütan koroner girişim grubunda belirgin olarak daha fazlaydı [hazard ratio, %95 GA: 0.12 (0.05-0.30), p< 0.001].Sonuç: Sx skoru ile değerlendirilen koroner lezyon kompleksitesi herhangi bir nedenle revaskülarizasyon sıklığı ile daha yakın ilişkilidir. Yüksek Sx skoru gubunda herhangi bir nedenden ölüm çıplak metal stent uygulanan hastalarda koroner baypas cerrahisine giden hastalara göre daha fazlaydıIntroduction: We aimed to compare the effects of coronary lesion complexity assessed by SYNTAX (Sx) score on the clinical outcomes in patients who have received BMS versus undergone coronary bypass grafting.Patients and Methods: Our study population consisted of 459 consecutive patients received bare metal stents (n= 265) or coronary bypass grafting (n= 294). The complexity of coronary artery disease was assessed by Sx score. Sx score was classifi ed as tertiles, as follows: low Sx score (? 22), intermediate Sx score and high Sx score (? 33).Results: Throughout the study, the intermediate-term incidence of any revascularization was signifi cantly higher in the percutaneous coronary intervention group compared with the coronary bypass grafting group for both overall group and Sx tertiles. The intermediate-term incidence of death from any cause was comparable between the treatment groups in patients with low and intermediate Sx tertiles. However, in patients with high Sx tertile, the intermediate-term incidence of death from any cause was signifi cantly higher in percutaneous coronary intervention group compared with coronary bypass grafting group. In the overall population, adjusted [hazard ratio, 95% CI: 0.88 (0.38-2.05), p= 0.780) risks for death from any cause were consistently comparable between percutaneous coronary intervention and coronary bypass grafting, whereas adjusted [hazard ratio, 95% CI: 0.12 (0.05-0.30), p< 0.001] risks for any revascularization were consistently signifi cantly higher in the percutaneous coronary intervention group compared with coronary bypass grafting group. Conclusion: Coronary lesion complexity assessed by SYNTAX score was closely associated with the higher incidence of any revascularization and in high SYNTAX score, with higher incidence of death from any cause in patients received bare metal stents than coronary artery bypass graftin