Long term clinical outcomes of brachytherapy, bare-metal stenting, and drug-eluting stenting for de novo and in-stent restenosis lesions: Five year follow-up

Background: We aimed to investigate the effects of brachytherapy, drug-eluting stent (DES) and bare metal stent (BMS) applications in the treatment of coronary artery disease, on five- -year clinical outcomes and mortality. Methods: Two hundred and seventeen patients who were treated in our clinics between January 2000 and December 2003 with brachytherapy, DES, or BMS for both de novo and in- -stent restenosis lesions were included in this cohort study. Of these 217 patients, 69 received brachytherapy, 80 were given BMS and 68 were given DES. The clinical outcomes of the patients during hospitalization and over a long-term follow-up were evaluated. Cardiovascular events, revascularizations and mortality rates were compared among the three groups over a five-year follow-up. Results: The mean age was 60.1 ± 9.5 years in the brachytherapy group, 55.7 ± 9.2 years in the BMS group, and 58.9 ± 9.8 years in the DES group (p = 0.44). All-cause mortality rates were 20 (29%) brachytherapy patients, 22 (27.5%) BMS patients, and four (5.9%) DES patients (p = 0.01). Cardiovascular event was the cause of death for 14 (20.3%) brachytherapy patients, 16 (20%) BMS patients and four (5.9%) DES patients (p = 0.001). All-cause mortality rates were 20 (29%) brachytherapy patients, 22 (27.5%) BMS patients and four (5.9%) DES patients. All-cause and cardiovascular mortality rates were significantly lower in the DES group compared to both the BMS and the brachytherapy groups (p = 0.01 and p = 0.001, respectively). Conclusions: DES application for in-stent restenosis and de novo lesions was superior to brachytherapy and BMS application with respect to all-cause and cardiovascular mortalities. (Cardiol J 2011; 18, 6: 654–661

Red Blood Cell Distribution Width in 'Non-Dippers' versus 'Dippers'

Objectives: Because both high red cell distribution width (RDW) and non-dipping hypertension are closely related to adverse cardiovascular outcomes and higher inflammatory status, we aimed to investigate whether there is any relationship between RDW and dipping/non-dipping hypertension status. Methods: The present study involved 123 hypertensive patients and 65 age-and gender-matched healthy, normotensive subjects. Hypertensive patients were divided into two groups: 56 dipper patients (20 males, mean age 51.9 +/- 15.3 years) and 67 non-dipper patients (27 males, mean age 55.6 +/- 15.0 years). If the systolic daytime blood pressure (BP) of the patients decreased by at least 10% during the night-time, these subjects were 'dippers', and all other subjects were 'non-dippers'. Results : Both dipper patients and non-dipper patients had higher levels of RDW compared to normotensives (13.5 +/- 0.89 and 14.1 +/- 1.33 vs. 13.0 +/- 1.42%, p = 0.027 and p <0.001, respectively). Also RDW values in non-dippers were statistically higher compared to those in dippers (p = 0.008). Although there were negative correlations between RDW values and nocturnal systolic BP fall (p = 0.027, r = -0.199) and diastolic BP fall (p = 0.383, r = -0.079) in all hypertensive patients, these correlations did not reach a statistically significant level. Conclusion: Our study demonstrates that non-dippers have high RDW levels compared to both dippers and controls. Copyright (C) 2012 S. Karger AG, Base

Platelet activation and inflammatory response in patients with non-dipper hypertension

Objective: Non-dipper hypertensives had about three times the risk of atherosclerotic events than hypertensives whose blood pressure was > 10% lower at night compared to daytime (dippers). Platelet activation and inflammatory response may derive from most atherosclerotic events. Mean platelet volume (MPV) is a determinant of platelet activation and high sensitive C-reactive protein (hs-CRP) is the best candidate assay to identify and monitor the inflammatory response. We aimed to determine whether MPV and hs-CRP levels are elevated in non-dipper patients compared to dippers and healthy controls. In addition, we tried to find out if MPV and CRP are related to each other or not in non-dipper hypertensives

Copeptin Level and Copeptin Response to Percutaneous Balloon Mitral Valvuloplasty in Mitral Stenosis

WOS: 000301616800010PubMed: 22343496We aimed to investigate copeptin levels in mitral stenosis (MS) patients and the behavior of copeptin after hemodynamic improvement achieved by percutaneous balloon mitral valvuloplasty (PBMV). The study involved 29 consecutive symptomatic patients with moderate to severe rheumatic MS who underwent PBMV. Twenty-eight age- and gender-matched healthy volunteers composed the control group. Blood samples for copeptin were obtained immediately before and 24 h after PBMV, centrifuged, then stored at -70 degrees C until assayed. The copeptin level of the patient group was statistically different from that of the control group (61.8 +/- 34.4 and 36.8 +/- 15.2 pg/ml, respectively; p = 0.001). PBMV resulted in a significant increase in mitral valve area and a significant decrease in transmitral gradient as well as systolic pulmonary artery pressure. While hemodynamic relief was obtained, we detected a statistically significant decline in copeptin levels 24 h after PBMV compared to the baseline levels (from 61.8 +/- 34.4 to 44.1 +/- 18.2 pg/ml; p = 0.004). Copyright (C) 2012 S Karger AG, Base

Surgical Approach to the Management of Cardiovascular Echinococcosis

Objective: Echinococcosis is a serious health problem in some regions of the world. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important. Methods: We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years. Results: The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence. Conclusions: Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk.OBJECTIVE:Echinococcosis is a serious health problem in some regions of the world. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important.METHODS:We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years.RESULTS:The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence.CONCLUSIONS:Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk

Plasma B-type natriuretic peptide in diagnosing inferior myocardial infarction with right ventricular involvement

Background B-type natriuretic peptide (BNP) is secreted from the ventricles in response to volume expansion and pressure overload. We aimed to investigate plasma BNP levels in inferior myocardial infarction (MI) with and without right ventricular MI (RVMI)