The effects of carotid artery stenting on short-term clinical outcomes and evaluation of restenosis

Objectives: Data on restenosis and long-term outcomes of carotid stenting are limited. The aim of this study was to investigate cardiovascular effects of carotid stenting on clinical outcome and restenosis in patients with symptomatic severe carotid artery stenosis.Materials and methods: Twenty patients (mean age: 68±7 years, 11 male) who have been decided to perform stenting in joint Committee of Cardiology, Cardiovascular Surgery and Neurology Clinics were included.Patients were evaluated both clinically and Doppler ultrasonographically for frequency of cardiovascular events and restenosis. Restenosis is defined as the reapperance of stenosis with a diameter reduction of ≥%50 with peak systolic velocity higher than 224 cm/s.Results: Comorbidities in patients were; coronary artery disease in 14, peripheral artery disease in three, and both chronic renal failure and congestive heart failure in two. Stent diameters were ranged from 6 to 8 mm, and stent lengths were 30 and 40 mm. During the procedure 5 patients had predilatation and 19 had postdilatation. None of the patients had >%30 resudial stenosis after the procedure. All procedures were technically successful. After the procedure only one transient ischemic attack was seen. There were no restenosis, myocardial infarction, death or stroke at 30th day end of the first year of follow up. Diabetes and heart failure were found as predictors for restenosis.Conclusion: In highly selected cases, carotid artery stenting is an effective and safe method in the short term. Restenosis did not seem to be a restricting problem for the success of carotid artery stentin

Czy wskaźnik powrotu rytmu zatokowego serca jest czynnikiem predykcyjnym omdlenia kardiodepresyjnego?

Background: Cardioinhibitory syncope is related with excessive bradycardia or asystole due to parasympathetic response. Aim: We investigated whether patients with cardioinhibitory syncope have higher heart rate recovery index (HRRi) considered as a parasympathetic system activation in exercise stress testing (EST) than in those with other neurogenic syncope forms. Methods: A total of 262 patients who had neurogenic syncope documented by head-up tilt test (HUTT) and 199 healthy control individuals were examined. A maximal EST was applied to all patients after the HUTT. The HRRi was obtained by subtracting the heart rate that was measured at the first (HRRi-1), second (HRRi-2), and third minute (HRRi-3) of the recovery period from the maximal heart rate that was measured during the test. Results: Eighty patients had cardioinhibitory syncope, 118 patients had vasodepressor syncope, and 64 patients had mixed-type syncope. The HRRi-1 was higher in patients with syncope (43.3 ± 7.7) compared to the control group (34.5 ± 4.8; p &lt; 0.001). Post hoc analysis showed that among the syncope groups, there was no difference between patients with vasodepressor syncope (42.2 ± 7.6) and those with mixed type syncope (40.7 ± 4.1) in terms of HRRi-1 (p = 0.420). However, patients with cardioinhibitory syncope (47 ± 8.7) had a higher HRRi-1 than vasodepressor and mixed-type syncope groups (p &lt; 0.05). The threshold value of the HRRi-1, which can be used for the prediction of cardioinhibitory syncope development, was determined to be 41 with 75% sensitivity and 72% specificity. Conclusions: The HRRi-1 was higher in patients with cardioinhibitory syncope compared to the controls. The HRRi-1 has the predictive feature of differentiating cardioinhibitory syncope from other syncope types.Wstęp: Omdlenia kardiodepresyjne wiążą się z silną bradykardią lub asystolią wynikającą z reakcji układu przywspółczulnego. Cel: Autorzy zbadali, czy u chorych, u których występowały omdlenia kardiodepresyjne, uzyskane w badaniu wysiłkowym (EST) wartości wskaźnika powrotu rytmu zatokowego (HRRi), uważanego za wskaźnik aktywacji układu przywspółczulnego, są wyższe niż u osób z innymi typami omdleń neurogennych. Metody: Do badania włączono 262 chorych z udokumentowanym omdleniem neurogennym w teście pochyleniowym (HUTT) i 199 zdrowych osób z grupy kontrolnej. Po teście HUTT u wszystkich uczestników wykonano próbę wysiłkową. Wartość wskaźnika HRRi obliczono przez odjęcie częstotliwości rytmu serca zmierzonej w pierwszej (HRRi-1), drugiej (HRRi-2) i trzeciej minucie (HRRi-3) po zakończeniu ćwiczeń od maksymalnej częstotliwości rytmu serca w trakcie testu. Wyniki: U 80 chorych wystąpiło omdlenie kardiodepresyjne, u 118 — wazodepresyjne, a u 64 chorych — omdlenie typu mieszanego. Wskaźnik HRRi-1 był wyższy u chorych, u których występowały omdlenia (43,3 ± 7,7), w porównaniu z grupą kontrolną (34,5 ± 4,8; p < 0,001). W analizie post hoc przeprowadzonej wśród osób z omdleniami nie stwierdzono różnicy między chorymi z omdleniami typu wazodepresyjnego (42,2 ± 7,6) a chorymi z omdleniami typu mieszanego (40,7 ± 4,1) pod względem wartości HRRi-1 (p = 0,420). Jednak u pacjentów z omdleniami typu kardiodepresyjnego (47 ± 8,7) wartość wskaźnika HRRi-1 była wyższa niż w grupach z omdleniami typu wazodepresyjnego i mieszanego (p < 0,05). Ustalono, że wartość progowa wskaźnika HRRi-1, którą można stosować w predykcji omdleń kardiodepresyjnych, wynosi 41, przy czułości 75% i swoistości 72%. Wnioski: Wskaźnik HRRi-1 był wyższy u chorych z omdleniami kardiodepresyjnymi niż w grupie kontrolnej. Wskaźnik HRRi-1 może być stosowany jako czynnik predykcyjny w różnicowaniu między omdleniami kardiodepresyjnymi a omdleniami innego typu

Prevalence of Fibromyalgia Syndrome and Its Correlations with Arrhythmia in Patients with Palpitations

Objective: It is aimed to determine the prevalence of fibromyalgia syndrome (FMS) and its correlations with arrhythmia in patients with palpitations. Material and Methods: Sixty-two patients who underwent electrophysiological study (EPS) due to palpitation complaints in Cardiology department and 40 healthy controls were included in the study. The precise diagnosis of arrhythmia was established using EPS. All participants were screened for FMS using American College of Rheumatology 2010 Fibromyalgia diagnostic criteria. Clinical assessments included measurement of severity of pain, fatigue and morning fatigue with visual analog scale (VAS), functional status with Fibromyalgia Impact Questionnaire (FIQ), and anxiety/depression with Hospital Anxiety and Depression Scale (HAD). Results: FMS was diagnosed in 22 of the 62 patients (36%), and 4 of the 40 healthy controls (10%) (p 0.05). EPS+ patients with FMS had higher fatigue levels, HAD and FIQ scores than EPS− patients, although statistically insignificant. HV durations were statistically longer in the EPS− subgroup (p < 0.05) but other EPS data were similar. Conclusion: FMS frequency and HAD anxiety scores were found to be higher in patients with palpitation complaints. However, we found no association between arrhythmia, EPS parameters and FMS. In our clinical practice we should keep in mind to carry out assessments in terms of FMS in patients with palpitation

Przydatność skali HATCH w prognozowaniu wystąpienia migotania przedsionków po zabiegu pomostowania aortalno-wieńcowego

Background: Atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery is associated with increased morbidity and mortality. The HATCH score was originally devised to predict the progression of paroxysmal AF to persistent AF. Aim: To determine whether the HATCH score predicts the development of AF after CABG surgery. Methods: The medical records of 284 consecutive patients, who underwent CABG surgery between January 2013 and December 2014, were retrospectively reviewed for the development of AF in the postoperative (POAF) period. The HATCH score, and clinical and echocardiographic parameters were evaluated for all patients. Results: Seventy (25%) patients developed POAF. The HATCH scores were higher in the POAF group (2.8 ± 1.8 vs. 1.1 ± 1.2, p &lt; 0.001). The area of the HATCH score under the curve in the receiver operating characteristics analysis was 773 (95% CI 706–841, p &lt; 0.001). When the HATCH score was 2 or more as a threshold, there was for POAF 72% sensitivity and 75% specificity. Conclusions: The results of the present study suggest that the HATCH score can be used to predict the development of POAF.Wstęp: Migotanie przedsionków (AF) po zabiegu pomostowania aortalno-wieńcowego (CABG) wiąże się ze zwiększoną chorobowością i śmiertelnością. Skala HATCH została opracowana pierwotnie w celu prognozowania progresji napadowego AF do przetrwałego AF. Cel: Celem niniejszego badania było określenie, czy skala HATCH umożliwia ocenę ryzyka rozwoju AF po zabiegu chirurgicznym (CABG). Metody: Dokumentację medyczną 284 kolejnych chorych poddanych CABG w okresie od stycznia 2013 r. do grudnia 2014 r. przeanalizowano retrospektywnie pod kątem rozwoju AF w okresie pooperacyjnym (POAF, AF in the postoperative period). U wszystkich pacjentów oceniono wskaźnik HATCH oraz parametry kliniczne i echokardiograficzne. Wyniki: Wystąpienie POAF odnotowano u 70 (25%) chorych. Wskaźnik HATCH był wyższy w grupie POAF (2,8 ± 1,8 vs. 1,1±1,2; p &lt; 0,001). Pole pod krzywą (AUC) dla wskaźnika HATCH w analizie krzywych ROC wynosiło 773 (95% CI: 706–841; p &lt; 0,001). Dla wartości wskaźnika HATCH większych lub równych wartości granicznej wynoszącej 2 czułość i swoistość w prognozowaniu POAF określono na, odpowiednio, 72% i 75%. Wnioski: Wyniki przedstawionego badania wskazują, że skala HATCH może być przydatna w prognozowaniu ryzyka rozwoju POAF

Decline in mean platelet volume in patients with patent foramen ovale undergoing percutaneous closure : cardiovascular topic

INTRODUCTION: The presence of patent foramen ovale (PFO) is considered a possible cause for cryptogenic stroke. The mechanism underlying the ischaemic neurological events in the presence of PFO has not been firmly established. The purpose of this study was to compare: (1) the mean platelet volume levels in PFO patients with and without a cryptogenic stroke, and (2) pre- and post-procedural mean platelet volumes (MPV) in patients undergoing percutaneous PFO closure. METHODS: Sixteen PFO patients undergoing percutaneous closure to prevent recurrent ischaemic events and 15 asymptomatic patients with PFO were enrolled in the study. Mean platelet volume was compared between patients with and without a history of stroke. We also compared pre- and postprocedural MPV levels in patients undergoing percutaneous PFO closure. RESULTS: Mean platelet volume, which is a marker for platelet activity, was similar in PFO patients with and without stroke (9.34 ± 1.64 vs 9.1 ± 1.34 fl; p = 0.526). Interestingly, MPV decreased significantly after percutaneous closure compared to pre-procedural levels (9.34 ± 1.64 vs 8.3 ± 1.12 fl; p = 0.001). CONCLUSION: Our findings suggest interatrial communication through a PFO may be related to increased MPV and increased platelet activity

Characteristics of patients with atrial fibrillation on edoxaban treatment in Turkey: Does health provider type matter? A report from ETAF-TR Study

[No Abstract Available