The association between TAPSE and right atrial contractile strain

BACKGROUND: In the descending arm of tricuspid annular plane systolic excursion (TAPSE) there is a notch formation which corresponds to the contractile phase of the atrial strain curve. Theoretically, this notch formation stands for atrial contraction. AIMS: We aim to characterize the notch formation on the TAPSE, the predictors of its existence, its relationship with the right ventricle and right atrial strain (RAS) parameters. METHODS: Retrospectively selected 240 patients were investigated for the determinants of the notch formation on TAPSE and the relation between RAS and TAPSE. RAS was analyzed using 2D speckle tracking in a dedicated mode for atrial analysis and reported separately for the reservoir, conduit, and contractile phases. RESULTS: 71.7% (n = 172) of patients had the notch formation on the TAPSE and 70.4% (n = 169) had a normal value of right atrial contractile strain (RASct). Most of the patients with a notch formation also had preserved RASct (95.9%; P <0.001). In multivariable analysis, RASct (odds ratio [OR], 1.45; 95% confidence interval [CI]: 1.13­­‒1.77; P = 0.020) remained significant with the notch formation. Receiver operator characteristic (ROC) analysis demonstrated that a RASct of ‒19% was found as a cut-off for presence of notch formation. ROC area was 0.897 (95% CI 0.844–0.951; P <0.001). CONCLUSIONS: The changes in TAPSE configuration represents the changes in atrial contractile phase. The descending arm of the TAPSE indicates the RASct as whether it is preserved or not. The notch formation persists if the RASct is above ‒19%. So, an easier, more applicable, and more effortless tool TAPSE can be used as an indicator of atrial contractile phase by its configuration in daily routine

Clinical usefulness of red cell distribution width to angiographic severity and coronary stent thrombosis

Background: Red cell distribution width (RDW) is a quantitative measurement and shows heterogeneity of red blood cell size in peripheral blood. RDW has recently been associated with cardiovascular events and cardiovascular diseases, and it is a novel predictor of mortality. In this study, we aimed to evaluate the clinical usefulness of measuring RDW in patients with coronary stent thrombosis. Patients and methods: We retrospectively reviewed 3,925 consecutive patients who presented with acute coronary syndrome and who underwent coronary angiography at the Siyami Ersek Hospital between May 2011 and December 2013. Of the 3,925 patients, 73 patients (55 males, mean age 59 +/- 11 years, 55 with ST elevated myocardial infarction) with stent thrombosis formed group 1. Another 54 consecutive patients who presented with acute coronary syndrome (without coronary stent thrombosis, 22 patients with ST elevated myocardial infarction, 44 males, mean age 54 +/- 2 years) and underwent percutaneous coronary intervention in May 2011 formed group 2. Data were collected from all groups for 2 years. The RDW values were calculated from patients 1 month later at follow-up. Syntax scores were calculated for all the patients. The patients were also divided as low syntax score group and moderate-high syntax score group. Results: The patients in group 1 with stent thrombosis had significantly higher RDW level (13.85) than the patients in group 2 without stent thrombosis (12) (P < 0.001). In addition, in all study patients, the moderate-high syntax score group had significantly higher RDW level (13.6) than the low syntax score group (12.9) (P = 0.009). A positive correlation was determined between RDW and syntax scores (r = 0.204). Conclusion: RDW is a new marker of poor prognosis in coronary artery disease. Increased RDW level is correlated with angiographic severity of coronary artery disease, and RDW may be an important clinical marker of coronary stent thrombosis in patients undergoing coronary intervention

Zależność między punktacją w skali Gensiniego a rezolucją uniesienia odcinka ST u chorych z ostrym zawałem serca z uniesieniem odcinka ST poddanych pierwotnej przezskórnej interwencji wieńcowej

Background: Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis.Aim: To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI).Methods: The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplastyand 60 min after pPCI. ΣSTR &lt; 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(–), and those with STR(+). Patients were also analysed according to the infarct-related artery.Results: GS-pPCI was significantly higher in patients with STR(–) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r = –0.287, p = 0.002). In subgroup analysis, patients in the STR(–) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(–) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03–1.12, p = 0.001 and OR 3.28, 95% CI1.11–9.72, p = 0.03, respectively).Conclusions: GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI. Wstęp: Stan kliniczny chorych, którzy przebyli zawał serca, zależy głównie od skutecznego przywrócenia perfuzji mięśnia sercowego i nasilenia zmian miażdżycowych w naczyniach wieńcowych.Cel: Celem pracy była ocena wartości predykcyjnej punktacji w skali Gensiniego w odniesieniu do rezolucji uniesienia odcinka ST (STR) u osób poddanych pierwotnej przezskórnej interwencji wieńcowej (pPCI) z powodu ostrego zawału serca z uniesieniem odcinka ST (STEMI).Metody: Do badania włączono 114 kolejnych pacjentów (średnia wieku 54 ± 10 lat, 15 kobiet) ze STEMI, u których wykonano — zakończony powodzeniem — zabieg pPCI. Obliczono łączne uniesienie odcinka ST w milimetrach przed angioplastyką i 60 min po pPCI. ΣSTR &lt; 50% uznano za elektrokardiograficzny wskaźnik zjawiska no-reflow. Stopień obciążenia skrzeplinami określono na podstawie koronarografii, a punktację w skali Gensiniego (GS-pPCI) obliczono po przeprowadzeniu pPCI, nie uwzględniając zmiany odpowiedzialnej za powstanie zawału. Pacjentów podzielono na dwie grupy w zależności od STR:STR(–) i STR(+). Chorych analizowano również w zależności od tętnicy odpowiedzialnej za zawał.Wyniki: U pacjentów z STR(–) wartość GS-pPCI była istotnie wyższa (10,1 ± 11,8 vs. 22 ± 18,6; p = 0,005). Stwierdzo noujemną korelację między GS-pPCI i STR (r = –0,287; p = 0,002). W analizie podgrup wykazano ponadto, że u chorych z grupy STR(–), u których zmiana będąca przyczyną zawału (culprit lesion) znajdowała się w gałęzi międzykomorowej przedniej lub gałęzi okalającej, wartości GS-pPCI były wyższe (odpowiednio 10,9 ± 13,5 vs. 23,5 ± 21,3; p = 0,03 i 9,6 ± 8,7 vs. 24,1 ± 21; p = 0,04). U pacjentów z STR(–) częściej stwierdzano również duże obciążenie skrzeplinami (68% vs. 43%, p = 0,03). W wieloczynnikowej analizie regresji logistycznej wykazano, że GS-pPCI i duże obciążenie skrzeplinami były niezależnymi czynnikami predykcyjnymi niedostatecznej STR (odpowiednio, OR 1,07; 95% CI 1,03–1,12; p = 0,001 i OR 3,28; 95% CI 1,11–9,72; p = 0,03).Wnioski: Wartość GS-pPCI i duże obciążenie skrzeplinami są ważnymi czynnikami predykcyjnymi niedostatecznej STR u chorych ze STEMI poddanych pPCI.

The relationship between epicardial adipose tissue and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 +/- A 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (Delta STR) < 70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 +/- A 1.7 vs. 5.4 +/- A 2, p = 0.001). EAT thickness was also found to be inversely correlated with Delta STR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI

Assessment of Tenascin-C Levels in Ventricular Noncompaction/Hypertrabeculation Patients: A Cross-Sectional Study

PurposeVentricular noncompaction/hypertrabeculation (NC/HT) is a rare form of congenital cardiomyopathy. We aimed to investigate the presence of serum tenascin-C (TN-C) in adult patients with NC/HT and evaluate its value

Wartość prognostyczna stężenia rezystyny w surowicy u chorych z ostrym zawałem serca

Background: Resistin is a novel adipokine that is suggested to be involved in inflammatory conditions and atherosclerosis.Aim: To investigate the prognostic importance of resistin in acute myocardial infarction (AMI) patients.Methods: Resistin levels were measured in a population of 132 patients with AMI, of whom 72 (54%) had a diagnosis of ST elevation myocardial infarction (STEMI), and 60 (46%) had non-ST elevation myocardial infarction (NSTEMI). Thirty-three consecutive subjects who were referred to elective coronary angiography due to chest pain evaluation with normal coronary angiograms served as controls. All patients were followed-up for the occurrence of major adverse cardiac events (MACE).Results: There was a significant increase in serum resistin levels in patients with AMI compared to controls (3.71 ± 4.20 vs. 2.00 ± 1.05, p = 0.001, respectively). However, serum resistin levels were similar in patients with STEMI and NSTEMI. (4.26 ± 5.11 vs. 3.06 ± 2.64, p = 0.49, respectively). The patients with MACE had significantly higher levels of serum resistin levels compared to either the AMI or the control group (6.35 ± 5.47, p = 0.005, respectively). Logistic regression analysis revealed that resistin, left ventricular ejection fraction, and coronary artery bypass graft were independent predictors of MACE in AMI patients (OR = 1.11, 95% CI 1.01–1.22, p = 0.03 and OR = 3.84, 95% CI 1.26–11.71, p = 0.018, respectively).Conclusions: Serum resistin level was increased in patients with AMI and constituted a risk factor for MACE in this group.Wstęp: Rezystyna jest nową adipokiną, która prawdopodobnie uczestniczy w procesach zapalnych i rozwoju miażdżycy.Cel: Celem niniejszego badania była ocena wartości prognostycznej rezystyny u chorych z ostrym zawałem serca (AMI).Metody: Zmierzono stężenia rezystyny w populacji złożonej ze 132 chorych z AMI, spośród których u 72 (54%) osób rozpoznano zawał serca z uniesieniem odcinka ST (STEMI), a u 60 (46%) — zawał serca bez uniesienia odcinka ST (NSTEMI). Grupę kontrolną stanowiło 33 kolejnych pacjentów skierowanych na angiografię wieńcową w trybie planowym z powodu bólu w klatce piersiowej, u których wykazano prawidłowy obraz tętnic wieńcowych. Wszystkich chorych obserwowano pod kątem wystąpienia poważnych niepożądanych zdarzeń sercowych (MACE).Wyniki: U pacjentów z AMI stwierdzono istotne zwiększenie stężenia rezystyny w surowicy w porównaniu z osobami z grupykontrolnej (odpowiednio 3,71 ± 4,20 vs. 2,00 ± 1,05; p = 0,001). Jednak u chorych ze STEMI i NSTEMI stężenia rezystyny były podobne (odpowiednio 4,26 ± 5,11 vs. 3,06 ± 2,64; p = 0,49). U pacjentów z MACE stężenia rezystyny w surowicy (6,35 ± 5,47; p = 0,005) były istotnie wyższe niż u chorych z AMI i osób z grupy kontrolnej. W analizie regresji logistycznej wykazano, że stężenie rezystyny, frakcja wyrzutowa lewej komory i pomostowanie aortalno-wieńcowe były niezależnymi czynnikami predykcyjnymi MACE u chorych z AMI (odpowiednio: OR = 1,11; 95% CI 1,01–1,22; p = 0,03 i OR = 3,84; 95% CI 1,26–11,71; p = 0,018).Wnioski: Stężenie rezystyny w surowicy było zwiększone u chorych z AMI i stanowiło czynnik ryzyka MACE w tej grupie chorych