Flash pulmonary edema: A rare cause and possible mechanisms

AbstractFlash pulmonary edema frequently develop in case of bilateral renal artery stenosis and unilateral renal artery stenosis with functional solitary kidney. In some rare cases, unilateral renal artery stenosis with bilaterally functional kidneys may also lead to flash pulmonary edema. Here, we present a case of flash pulmonary edema caused by accessory renal artery stenosis. To our knowledge, it is the first case reported in the literature

The role of prognostic nutritional index in predicting amputation in patients with lower extremity peripheral artery disease

Introduction: Lower-extremity peripheral artery disease (PAD) can lead to a wide spectrum of symptoms that can progress from claudication to amputation. The prognostic nutritional index (PNI), which is calculated using the levels of albumin and lymphocyte, is an accepted indicator of immunological and nutritional status. In this study, the association between nutritional status determined using the PNI, and extremity amputation in patients with lower-extremity PAD was investigated. Methods: Lower-extremity PAD patients who had been admitted to the cardiology clinic of the Dışkapı Yıldırım Beyazıt Training & Research Hospital with stage 2b or higher claudication, and who were technically unsuitable for revascularization or underwent unsuccessful revascularization procedure were enrolled in this retrospective study. Patients were grouped according to whether or not limb amputation had been performed previously. Potential factors were tested to detect independent predictors for amputation with logistic regression analysis. Results: A study group was formed with 266 peripheral artery patients. The amputated group (39 patients) had a higher number of hypertensive (76.9% vs 57.7%; P = 0.032) and diabetic (92.3% vs 54.2%; P <0.001) patients than those in the non-amputated group (227 patients). The median PNI value of the amputated group was lower than that of the non-amputated group (31.8 vs 39.4; P <0.001). Multivariate logistic regression showed that the PNI (OR: 0.905, 95% CI: 0.859 – 0.954; P <0.001) was independently related with amputation. Conclusion: Immune-nutritional status based on PNI was independently associated with limb amputation in patients with lower-extremity PAD

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

Kardiyak Resenkronizasyon Tedavisinin Kalp Yetersizliğine Etkisinin Moleküler Biyolojik Temellerinin Araştırılması.

Heart failure is a complex clinical syndrome characterized by impaired myocardial performance and neuroendocrine system activation. Heart failure, appears to result not only from cardiac overload or injury but also from a complex interplay among genetic, neurohormonal, inflammatory, and biochemical changes acting on cardiac myocytes, the cardiac interstitium, or both. There are several biochemical changes in dyssynchronous heart failure rather than simple electrical stimulation problem. Pathogenetic pathways can be divided in six groups (inflammation, oxidative stress, extracellular-matrix remodeling, neurohormones, myocyte injury and myocyte stress) that involved several biomarkers. In the present study, six groups of biomarkers investigated in same patients before implantation and twelve months after. These biomarkers were interleukin-6, high sensitive C-reactive protein, myeloperoxidase, uric acid, matrix metalloproteinases-2 and 9, plasma procollagen type III, endothelin-1, troponin T, creatine kinase MB fraction, brain natriuretic peptide. Following CRT implantation, patients were monitorized for 12 months with echocardiographic evaluations defining responders by a 15% reduction in end-systolic volume. Levels of MPO, MMP-2, Troponin T, and BNP were significantly decreased in responder group [21,9 ng/ml (75,7-84,4) vs. 11,8 ng/ml (0,9-18,4), p=0,001; 128,1 ng/ml (84,1-218,0) vs. 64,3 ng/ml (5,6-172,9), p=0,001; 0,035 ng/ml (0,003-0,459) vs. 0,015 ng/ml (0,003-0,042), p=0,004; 164,5 pg/ml (13,0-1990,0) vs. 106 pg/ml (10-983), p=0,007, respectively]. Levels of MPO, MMP-2 were significantly decreased and level of uric acid was significantly increased in non-responder group [33,0 ng/ml (0,9-99,1) vs. 10,1 ng/ml (2,4-16,9), p=0,040; 151,9 ng/ml (85,8-243,7) vs. 101,6 ng/ml (54,2-181,3), p=0,003; 5,82±1,93 mg/dl vs. 7,25±2,25 mg/dl, p=0,030, respectively]. The greatest improvement was found in extracellular matrix remodeling (effect size=0,700, p=0,001) in CRT-responder patients. Significant reduction was also found in the level of oxidative stress (effect size=0,489; p=0,001 and myocyte stress (effect size=0,210; p=0,007). However, significant changes in inflammation, myocyte injury and neurohormones cannot be detected in CRT-responder patients.Kalp yetersizliği, miyokard performansında bozulma ve nöroendokrin sistem aktivasyonu ile seyreden kompleks bir klinik sendromdur. Önceleri, kardiyak yüklenme veya hasarın kalp yetersizliğinden sorumlu olduğu düşünülürken son yıllarda yapılan çalışmalarda miyosit ve/veya kardiyak interstisiyumu etkileyen kompleks genetik, hormonal, inflamatuvar ve biyokimyasal değişikliklerin çok önemli rol oynadığı gösterilmiştir. Kalpteki senkronizasyon bozukluğu basit bir elektriksel uyarı gecikmesinden çok, sonrasında meydana gelen çeşitli biyokimyasal değişiklikleri beraberinde getirmektedir. Hastalık sürecindeki patogenetik yolaklar altı gruba (inflamasyon, oksidatif stres, ekstraselüler matriks yeniden şekillenmesi, nörohormonlar, miyosit hasarı ve miyosit stresi) ayrılmıştır. Çalışmamızda bu altı patogenetik yol aynı hasta grubunda işlem öncesinde ve on iki ay sonrasında araştırılmıştır. Çalışılan biyobelirteçler şunlardır: interlökin-6, yüksek duyarlıklı C-reaktif protein, miyeloperoksidaz(MPO), ürik asit, matriks metalloproteinazı (MMP)-2 ve 9, plasma prokollagen tip III, endotelin-1, troponin T, kreatin fosfokinaz MB fraksiyonu ve B-tip natriüretik peptid (BNP). Ekokardiyografik olarak sistol sonu hacminde %15 fazla azalma görülen hastaların KRT’ye yanıt verdiği kabul edilmiştir. Yanıt veren grupta MPO, MMP-2, Troponin T ve BNP düzeylerinde anlamlı azalma görülmüştür [sırasıyla 21,9 ng/ml (75,7-84,4) ‘e karşı 11,8 ng/ml (0,9-18,4), p=0,001; 128,1 ng/ml (84,1-218,0)’e karşı 64,3 ng/ml (5,6-172,9), p=0,001; 0,035 ng/ml (0,003-0,459)’e karşı 0,015 ng/ml (0,003-0,042), p=0,004; 164,5 pg/ml (13,0-1990,0) ’e karşı 106 pg/ml (10-983), p=0,007]. Yanıt vermeyen grupta ise MPO, MMP-2 düzeyinde anlamlı azalma görülürken, ürik asit düzeyinde anlamlı artış izlenmiştir [sırasıyla 33,0 ng/ml (0,9-99,1) ’e karşı 10,1 ng/ml (2,4-16,9), p=0,040; 151,9 ng/ml (85,8-243,7)‘e karşı 101,6 ng/ml (54,2-181,3), p=0,003; 5,82±1,93 mg/dl‘ye karşı 7,25±2,25 mg/dl, p=0,030]. Yapılan analizler sonucunda en fazla değişim KRT’ye yanıt veren hastalarda, yeniden şekillenmeyi gösteren biyobelirteç grubunda görülmüştür (etki genişliği=0,700, p=0,001). Bunu oksidatif stres (etki genişliği= 0,489; p=0,001) ve miyosit stresinde (etki genişliği= 0,210; p=0,007) azalma takip etmiştir. Miyosit hasarını, inflamatuvar ve nörohormonal değişiklikleri gösteren biyobelirteç gruplarında ise anlamlı değişiklik izlenmemiştir. Sonuç olarak oksidatif stresi ve miyosit stresini azaltmakla birlikte yanıt veren hastalarda KRT, bu etkisini en fazla ekstraselüler matriks yeniden şekillenmesini düzelterek gerçekleştirmektedir

Cryoballoon ablation of focal atrial tachycardia originating from right atrial appendage

The right atrial appendage (RAA) is a rare site of focal atrial tachycardia (AT). Sometimes, catheter ablation cannot successfully be accomplished at this location due to the difficulty in reaching the exact ablation site as well as the associated possible life-threatening complications like pericardial tamponade or perforation. Although radiofrequency (RF) ablation is preferred for the treatment of RAA tachycardias, alternative tools may be required in rare instances. This report presents a case of RAA tachycardia that was not terminated by RF ablation, instead, has been successfully ablated using cryoballoon. In addition, an overview of the literature and therapeutic options for the AT originating from RAA have also been included.PubMedScopu

Effects of familial mediterranean fever on cardiac functions in adults: A cross-sectional study based on speckle tracking echocardiography

WOS: 000469269200010Objectives: This study aims to evaluate the right ventricular (RV) and left ventricular (LV) systolic and diastolic functions with speckle tracking echocardiography in addition to routine echocardiographic measurements in adult familial Mediterranean fever (FMF) patients in order to detect cardiac functions. Patients and methods: Sixty FMF patients (23 males, 37 females; median age 35 years; interquartile range, 26 to 38 years) and 20 healthy subjects (10 males, 10 females; median age 31 years; interquartile range, 25 to 35 years) were included in the study. The diagnosis was established according to the Tel-Hashomer criteria. All patients were using regular colchicine and they were in the attack-free period. Laboratory examinations included complete blood count, creatinine, and inflammatory markers. In addition to routine echocardiographic examination, RV and LV global longitudinal strains were measured and compared. Results: Erythrocyte sedimentation rate and C-reactive protein values were higher in FMF group. LV global longitudinal strain was similar among the groups. FMF patients had slightly lower early diastolic trans-mitral flow (E) values than controls. As similar as the mitral E flow, tricuspid E flow was slightly lower in FMF groups than controls. RV ejection fraction was similar and in normal ranges among the groups. RV global longitudinal strain was lower in FMF group than controls. RV Myocardial Performance Index (or Tei index) was higher in FMF group. Conclusion: The present study indicates low values of mean RV global longitudinal strain and higher Tei index in FMF patients. These results suggest that FMF may cause subclinical RV deterioration