Determinants of coronary angiography in Non-ST-elevation myocardial infarction with low ejection fraction

Objective: To investigate the clinical and demographic factors affecting the selection of angiography in patients with severe left ventricular systolic dysfunction (SLVSD, ejection fraction lower than 30%) developing non-ST-segment elevation (NSTEMI). Study Design: Descriptive study. Place and Duration of Study: This study was conducted at the Department of Cardiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey, between March 2018 and March 2021. Methodology: Patients with SLVSD (Ejection fraction = 2 [Odds ratio (OR) :33.85, 95% Confidence Interval (CI): 5.03-227.405 p= 65 years (OR: 7.124, 95% CI: 1.33-38.12, p=0.02), and PCI history (OR: 0.132, 95% CI: 0.02-0.84, p=0.032) were associated factors with the decision of only medical treatments instead of angiography. Conclusion: Demographic factors such as age and education level and clinical factors such as decompensation, PCI history, and anaemia significantly affect the decision of angiography in the patients with SLVSD and NSTEMI

Clinical features and factors affecting in-hospital mortality of patients who underwent pericardiocentesis due to moderate to severe pericardial effusion

Introduction: The aim of this study was to determine the primary etiology of pericardial effusion in patients undergoing percutaneous pericardiocentesis. Possible in-hospital mortality related predictors were also investigated. Patients and Methods: A retrospective analysis was made of the clinical and laboratory features of 268 patients who underwent pericardiocentesis due to moderate to severe pericardial effusion between January 2009 and March 2020. Results: The patients comprised 57.5% males and 42.5% females with a mean age of 62.3 ± 15.4 years. Cardiac compression was detected in 220 (82.1%) patients, of which 208 (77.6%) were clinically tamponade and 12 (4.5%) were asymptomatic cardiac compression. The most common symptom was dyspnea (58.6%) and 10.8% of patients were asymptomatic. Pericardial fluid was exudate in 235 (87.7%) patients. The most common causes were malignancy (37.3%) followed by idiopathic (22.1%) and iatrogenic (12.7%) causes. The patients with asymptomatic cardiac compression were more likely to have malignant effusion than those with other etiologies (p= 0.001). In-hospital mortality developed in 37 (13.8%) patients. The independent predictors of in-hospital mortality were determined as follows; etiology other than infectious or idiopathic (OR= 3.447; 95% CI= 1.266, 9.386; p= 0.015), and receiving antithrombotic therapy (OR= 2.306; 95% CI= 1.078, 4.932; p= 0.031). Conclusion: Malignancy is the most common cause of moderate to severe pericardial effusions. The detection of cardiac compression in asymptomatic patients may be an important indicator of malignancy. Receiving antithrombotic therapy and having a non-idiopathic and non-infectious etiology may be predictors of in-hospital mortality

Is myocardial bridge more frequently detected on radial access coronary angiography?

Background: Although the incidence of myocardial bridge (MB) has been defined in different femoral access conventional coronary angiography (FACCA) studies, the frequency of MB on radial access coronary angiography (RACA) is unknown. The aim of this study was to determine the difference in the incidence of MB between patients undergoing RACA and FACCA. Method: A total of 2500 consecutive patients who underwent RACA and a total of 1455 consecutive patients who underwent FACCA were retrospectively investigated to detect the presence of MB. The incidences of the groups were calculated separately and compared. The clinical and angiographic features of the patients with MB were analyzed. Results: MB was detected at an incidence of 10.2%, in 255/2500 patients who underwent RACA, and 1.8% in 27/1455 patients who underwent FACCA (p < 0.001). In both RACA and FACCA patients, the most involved coronary artery was the left anterior descending artery (LAD) (86.9% and 93.1%) and the mid-segment (84.9% and 88.9%) was the most affected section. Co-involvement of multiple coronary arteries by MB was 7.8% in patients who underwent RACA and 7.4% in patients who underwent FACCA. Coronary artery disease (CAD) was determined in 111 (35.7%) of the coronary arteries with MB, of which 81.9% were proximal to the MB. No significant CAD was detected in any of the vessels of 69.8% (178/255) of the patients who underwent RACA for different clinical indications. Conclusion: These data demonstrated that the incidence of myocardial bridge able to be detected on RACA was much higher than FACCA

İnvestigation of Left Ventricular Systolic and Diastolic Functions Before and After Levosimendan Administration in Patients with Heart Failure

Background: we aimed to investigate effect of levosimendan treatment on left ventricle systolic and diastolic parameters with transthoracic echocardiography in patients with heart failure Method: Patients over 18 years old with lower than %35 of ejection fraction and New York Heart Association (NYHA) class III-IV were included. Left ventricle systolic and diastolic parameters before and after levosimendan treatment were compared. Approval was obtained from the local ethics committee of Celal Bayar University Medical Faculty for our study. Results: With levosimendan treatment; E/A ratio(2,25±0,76 vs 1,67±0,75 , p:0,03 ) and E/E’ ratio (23,03±13,60 vs 15,96±8,43 , p:0,01) decreased significantly. Furthermore there was an increase in ejection fraction(20,60±5,65 vs 27,00±7,11 , p:0,01) and A velocity( 0,45±0,14 vs 0,61±0,30 , p:0,03). Conclusion: Levosimendan treatment has an acute favoruble effect in ejection fraction and diyastolic mitral inflow parameters that showed ventricle overloa

COVID-19 Salgını Döneminde Valvüler Olmayan Atriyal Fibrilasyon Nedeniyle Yeni Nesil Oral Antikoagülan Kullanan Hastalarda Kanama Komplikasyonlarının Araştırılması

Amaç: COVID?19 pandemisi döneminde hastane başvurularının azalması; yeni oral antikoagülan kullanan hastaların takibini zorlaştır? maktadır. Bu bağlamda COVID?19 pandemisi döneminde yeni oral antikoagülan kullanan hastalarda kanama sıklığının araştırılması amaçlandı. Gereç ve Yöntem: Bu çalışma Mayıs 2020 ve Mayıs 2021 tarihleri arasında yapılmış kesitsel bir çalışmadır. COVID?19 pandemi döne? minde en az bir yıldır yeni oral antikoagülan kullanan 216 hasta dahil edilmiştir. Hastaların majör ve minör kanama oranları ve buna et? ki eden ön gördürücüler araştırılmıştır. Bulgular: Hastaların yaş ortalaması 72±10’du ve 129 (%60) hasta kadındı. 46 (%21) hastada kanama saptandı (%3 majör, %18 minör kanama). Kanama gelişen %12 hastada doz azaltımı yapılırken, %7 hastada ilaç kesilmiştir. Çok değişkenli analizlerde düzensiz ilaç kul? lanımı risk oranı: 14,91 (%95 Güven aralığı: 2,451?90,692, p=0,003), kadın cinsiyet risk oranı: 5,507 (%95 güven aralığı: 2,117?14,327, p<0,001), diyabet risk oranı: 2,319 (%95 güven aralığı: 1,069?5,031, p=0,033), HAS?BLED skoru risk oranı: 1,571 (%95 güven aralığı: 1,035?2,384 p=0,034) kanama ile ilişkili bağımsız değişken olarak bulunmuştur. Sonuç: Yeni oral antikoagülan kullanan hastalarda kanama komplikasyonları COVID?19 döneminde de hala bir sorun olmaya devam et? mektedi

Platelet-Lymphocyte ratio is a predictor for the development of no-reflow phenomenon in patients with ST-segment elevation myocardial infarction after thrombus aspiration

Backround We aimed to evaluate the utility of the preprocedural platelet-lymphocyte ratio (PLR) for predicting the no-reflow phenomenon after thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Method We retrospectively analyzed postprocedural thrombolysis in myocardial infarction (TIMI) flow grades and myocardial blush grades (MBG) of 247 patients who underwent a PCI procedure with thrombus aspiration.We divided these patients into two groups according to whether they had no-reflow (TIMI = 2). Results No-reflow developed in 43 (17%) patients.Preprocedural PLR was significantly higher in the no-reflow group (183.76 +/- 56.65 vs 118.32 +/- 50.42 p < 0.001).Independent predictors of no-reflow were as follows: higher preprocedural platelet-lymphocyte ratio (PLR) (OR = 1.018; 95% CI = 1.004, 1.033; p = 0.013),mean corpuscular volume (MCV) (OR = 1.118; 95% CI = 1.024, 1.220; p = 0.012) and SYNTAX Score-2 (OR = 1.073; 95% CI = 1.005, 1.146; p = 0.036). PLR of 144 had 79% sensitivity and 75% specificity for the prediction of no-reflow. Conclusion PLR is a reliable predictor for no-reflow in STEMI patients undergoing thrombus aspiration

Spontaneous right coronary artery dissection in a patient with COVID-19 infection: A case report and review of the literature

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global coronavirus disease 2019 (COVID-19) pandemic. Although SARS-CoV-2 predominantly causes viral pneumonia, it is also associated with many cardiovascular complications such as myocarditis, acute myocardial infarction, and thrombosis. Spontaneous coronary artery dissection (SCAD) is a rare form of coronary artery disease, which a few recent case reports have shown to be associated with COVID-19. The case reported here is a COVID-19 associated SCAD in a patient with no history of cardiovascular disease. The SCAD was treated with stent implantation

Is coronary artery tortuosity a predisposing factor for drug-eluting stent restenosis?

Background Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis. Methods The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software. Results Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 +/- 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127-1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062-1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity. Conclusion The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery

Mitral Valve Obstruction Caused by Heart-shaped Large Left Atrial Myxoma

Myxoma is one of the most common benign primary cardiac tumors, usually detected at ages between 30 and 60 years. It accounts for 50% of the primary cardiac tumors. The most common location of a myxoma is the left atrium. Myxomas are more prevalent in females. The clinical outcomes can differ depending on the tumor’s size, location, and architecture. The clinical picture can mimic mitral stenosis, which causes mitral valve obstruction. Syncope is a rare but life-threatening symptom and requires early surgical treatment. This paper describes a patient with a large left atrial myxoma, causing mitral valve obstructio