Incidental Detection of Coronary Artery Calcifications on Non-Cardiac Thoracic Ct Examinations

Objective: Strong relationships have been demonstrated between the presence of occlusive coronary artery disease and coronary artery calcifications detected at autopsy, fluoroscopy, or computed tomography (CT). The aim of our study was to evaluate the frequency of incidental coronary artery calcifications during thoracic CT examinations and to correlate them with cardiac risk factors. Materials and Methods: Thoracic CT scans obtained over a period of 6 months from 113 patients (72 male and 41 female) with a mean age of 62,7 (31-92 years) were retrospectively evaluated. The thoracic scans were performed using standard 9 mm consecutive slices from the apex to the base of the thorax, using a standard thoracic protocol, on a Siemens 16 channel multislice CT scanner. Coronary arteries were evaluated for calcifications. Results: Thirty-seven patients (32.7%) had coronary calcifications. 18 patients (15.9%) had one, 9 patients (7.9%) two, 7 patients (6.2%) three, and 3 patients (2.6%) had four vessels with calcifications. The frequency of coronary calcifications was correlated with hypertension, diabetes mellitus, hypercholesterolemia, nicotine abuse, and cardiomegaly. Diabetes mellitus, hypercholesterolemia, cardiomegaly and male gender were significantly associated with coronary calcifications (p< 0.05). Conclusion: With the advent of multislice faster CT scanners, coronary artery calcifications are more frequently and easily detectable during non-cardiac thoracic CT examinations. This retrospective study showed increased incidence of coronary calcifications in patients with cardiac risk factors. Among these factors diabetes mellitus, hypercholesterolemia, cardiomegaly and male gender were statistically significant

Exercise-induced repolarization changes in patients with isolated myocardial bridging

PubMed ID: 26198682Background: Although myocardial bridging (MB) is defined as an angiographic phenomenon with a benign course, it has also been associated with adverse cardiovascular events. The effects of exercise on myocardial repolarization in patients with MB were tested in this study, with Tp-e and Tp-e/QT repolarization indexes. Material/Methods: A total of 50 patients in whom isolated MB was diagnosed at coronary angiography (CAG) (Group I) and 48 patients with normal CAG results (Group II) were included in this study. The participants underwent treadmill exercise stress testing according to the Bruce protocol. QT dispersion (QTd) was defined as the minimum QT interval subtracted from the maximum. The Tp-e interval was defined as the difference between the QT and the QT peak time period. QTd and Tp-e intervals were calculated for all patients before and after exercise testing and differences between groups were compared. Results: At peak exercise, QTd and cQTd showed a significant increase in comparison to baseline values in the group of patients with myocardial bridges. Significant increases were also found with exercise in the Tp-e, cTp-e durations and Tp-e/QT ratio of the MB patient group in comparison to the baseline values. On the other hand, significant differences in QTd, cQTd, Tp-e, cTp-e intervals, and Tp-e/QT ratio during peak exercise in comparison with baseline values were not detected in the control group (p>0.05). Conclusions: Significant increases in QTd, cQTd, Tp-e and cTp-e intervals and Tp-e/QT ratio were detected in the MB patients during exercise testing

Physician and patient preferences for oral anticoagulation therapy decision-making in atrial fibrillation: Results from a national best-worst scaling survey in Turkey (PREF-AF)

Objectives Cost-utility modeling informs reimbursement decisions and is based on the premise that health outcome improvements can be expressed as disease-independent utility scores. Previous cost-utility analyses of anti-calcitonin gene-related peptide therapies expressed the utility gain as a function of monthly migraine days (MMDs). Exploring the presence of an additional treatment effect on utility after controlling for MMDs can be insightful. This post hoc analysis of the DELIVER clinical trial (NCT04418765) for the preventive treatment of migraine aims to communicate the impact of eptinezumab on health utility scores. Methods Utility scores were estimated using data from study visits at which the Migraine-Specific Quality of Life Questionnaire (MSQ) was completed. MSQ scores were then mapped to EQ-5D-3L using previously published algorithms. A linear mixed model evaluating the effect of eptinezumab compared to placebo using change from baseline at week 12 and 24, adjusted for MMDs, was generated, and a fixed intercept for each study arm was used to estimate if eptinezumab effected points compared to placebo beyond MMD reduction

IMPORTANCE OF ROENTGEN TUBE ANGLES IN CINEFLUOROSCOPIC INVESTIGATION OF MECHANICAL PROSTHESES

Aim. We planned a cinefluoroscopy (CF) study to mark the ideal opening and closing tube angles for mitral and aortic positioned mechanical valves. Our hypothesis was that if we find an intensity zone where the valves were optimally seen, then starting the CF examination from that tube position would shorten the examination durationMaterial and methods. Between January 2010 and August 2011, 192 consecutive patients (mean age 51,86±12,80 years; 101 women and 91 male) with mitral (n=135; monoleaflet: 37; bileaflet: 98) and aortic (n=87; monoleaflet:19; bileaflet: 68) and tricuspid (n=3; all bileaflet) prostheses were enrolled into the study. Cinefluoroscopy was performed with Philips Radiologic System. For each type and location of mechanical prostheses optimal opening-closing angles obtained and marked on x-y axis graphic. Furthermore, we investigated whether there is an intensity zone quadrant.Results. Among patients with prosthetic bileaflet mitral valve in supine position optimal images were obtained: 34 (58,6%) patients were in RAO-Cranial, 12 (20,7%) were in left anterior oblique (LAO) cranial, 7 (12,1%) were in RAO caudal and 5 (8,6%) were in LAO caudal angles. Among patients with prosthetic bileaflet aortic valves in supine position shown: 27 (50%) patients were in LAO-cranial, 10 (18,5%) were in RAO- cranial, 9 (16,7%) were in LAO-caudal and 8 (14,8%) patients were in RAO-caudal angles.Conclusion. According to our results it seems logical to start mitral position CF assessment by RAO-Cranial angles quadrant and for aortic position by LAO-Cranial angles quadrant to decrease time and lower radiation exposure

The Role of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) in Atrial Fibrillation: Treatment Management Based on Patient and Drug Characteristics

Data from Turkey revealed that atrial fibrillation patient percentage under adequate anticoagulation in Turkey is less than that in other countries due to multiple parameters such as treatment adherence problems, failure to follow guideline recommendations, negative perspective on the use of new drugs, drug costs, and payment conditions. The aim of this article is to provide physicians with a compiled resource that focuses on the differences between non-vitamin K antagonist oral anticoagulants and heterogeneity of atrial fibrillation patients by reviewing the global and national data from a multidisciplinary perspective and provide guidance on the choice of non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients. A gastroenterologist, 2 neurologists, and 11 cardiologists from university and training and research hospitals in Turkey who are experienced in atrial fibrillation and non-vitamin K antagonist oral anticoagulant treatments gathered in 3 separate meetings to identify the review topics and evaluate the outcomes of the systematic literature search. Based on the pharmacological characteristics, clinical studies, and real-world data comparisons, it has been revealed that non-vitamin K antagonist oral anticoagulants are not similar. Thromboembolism and bleeding risks, renal and hepatic functions, coexisting conditions, and concomitant drug usage have been shown to affect the levels of benefits gained from non-vitamin K antagonist oral anticoagulant in atrial fibrillation patients. Although Turkish patients with atrial fibrillation have been observed to be younger, they are more likely to have coexisting cardiovascular conditions compared to the atrial fibrillation patients in other countries. Selection of an appropriate non-vitamin K antagonist oral anticoagulant in line with the available evidence and recent guidelines will provide substantial benefits to atrial fibrillation patients

Assessment of NOAC dosing patterns in Turkish patients with non-valvular atrial fibrillation: A multicenter, cross-sectional study with insights from the ASPECT-NOAC study

AbstractAim: We aimed to assess the real‐world label adherence of non‐vitamin K antagonist oralanticoagulant (NOAC) dosing patterns, including apixaban, edoxaban, and rivaroxaban, as wellas their clinical outcomes in Turkish patients with atrial fibrillation (AF).Methods: This was an observational, prospective, multicenter study. Patients with AF who wereprescribed NOACs within the last 4 months were recruited from 34 cardiology clinics in Turkey.Baseline data were initially collected, and patient awareness was evaluated at 3–4 weeks. Thefinal study visit was conducted at 12 months.Results: A total of 903 patients were enrolled in the study. The mean age was 72.84 ± 10.17years, and 475 patients (52.6%) were female. We found that 140 (15.5%), 721 (79.8%), and 42patients (4.7%) were prescribed off-label low, on-label, and off-label high dosing, respectively.The age of the patients in the on-label group was significantly lower than that of those in the off-label low and off-label high groups (both p&amp;lt;0.001). Additionally, female patients were morefrequently observed in the off-label high group (p=0.019), and patients in the off-label low andon-label groups were significantly more obese than those in the low-label group (p&amp;lt;0.001). Theperception of income levels also revealed significant differences between the groups (p=0.010).Furthermore, the HAS-BLED scores were significantly lower in the on-label group than in theother groups (both p&amp;lt;0.001). Similarly, the CHA 2 DS 2 -VASc scores were significantly lower inthe on-label group than in the off-label group (p&amp;lt;0.001).Conclusion: Off-label low-dose NOAC prescriptions were relatively common in Turkishpatients; however, this was much lower than in previously reported results. Increasing clinicianawareness of appropriate NOAC dosing may help identify at-risk patients.Keywords: atrial fibrillation, anticoagulants, NOACs, dosing pattern, patient medicationknowledge</p

Atypical Chest X-Ray Calcification in an Idiopathic Constrictive Pericarditis Case

Constrictive pericarditis is an uncommon cause of heart failure. It is a clinical entity caused by thickening, fibrosis, and/or calcification of the pericardium. We present a 50-year-old female patient who was admitted to our institution with a 6-month history of progressive dyspnea on exertion, abdominal swelling, and lower extremity edema. Her chest X-ray revealed an oblique linear calcification in the cardiac silhouette. Transthoracic echocardiography revealed biatrial enlargement. Left ventricular size and systolic function were normal. Cardiac computed tomography revealed the pericardial thickening (>5 mm) and heavy calcification in left atrioventricular groove. Simultaneous right and left heart catheterization showed elevation and equalization of right-sided and left-sided diastolic filling pressures, with characteristic dip, and plateau. Pericardiectomy was performed which revealed a thick, fibrous, calcified, and densely adherent pericardium constricting the heart. The postoperative period was uneventful and was in NYHA functional class I after 3 months