Plasma YKL-40 Elevation on Admission and Follow-Up Is Associated with Diastolic Dysfunction and Mortality in Patients with Acute Myocardial Infarction

Objective. The aim of the study was to determine an association between the plasma YKL-40 level and echocardiographic left ventricle systolic and diastolic function parameters in patients with acute myocardial infarction. Subjects and Methods. The study included 46 patients with acute myocardial infarction. Serum brain natriuretic protein (BNP) and YKL-40 levels were analyzed on admission and after one month. Left ventricle systolic and diastolic functions and Tei index were computed by transthoracic echocardiography. Results. Plasma YKL-40 was significantly higher in patients with acute myocardial infarction (AMI) (101.7 μg/L versus 34 μg/L, resp., p<0.001) and remained higher than in healthy subjects after one month. The levels of YKL-40 on admission were correlated with log BNP on admission (r=0.41,p=0.004), Tei index (r=0.44,p=0.002), left atrium volume index (r=0.32,p=0.02), and mitral septal annular E/e′ (r=0.44,p=0.003). Death was more frequently observed in patients with plasma YKL-40 above the median value than in those with plasma YKL-40 below the median value (p=0.001; OR = 13.6 (2.5–72.3)). Conclusion. YKL-40 elevations in patients with AMI remain at least one month and are associated with serum BNP elevations, diastolic dysfunction, and long-term increased overall mortality. It has prognostic importance in patients with AMI

INADVERTENT COMPLICATION OF PROSTHETIC VALVE SURGERY: LEAFLET PERFORATION

There are various complications of prosthetic valvular surgeries. Among them, leaflet perforation should be emphasized and brought to mind when there have been eccentric valvular regurgitation. In this report, we presented 2 cases of iatrogenic aortic and mitral valve leaflet perforation after prosthetic valve surgeries

DIGOXIN TOXICITY IN THERAPEUTIC SERUM LEVELS

Aim:The purpose of this study, to evaluate digoxin toxicity and risk factors leading to digoxin toxicity in patients with therapeutic digoxin levels.Material and Methods: We studied ninety–five patients with digoxin level was above of the 1.4 ng/mL and below of the 2.0 ng/mL at admission. They were divided into two groups, drug toxicity or nontoxicity, on the basis of both clinical symptoms and electrocardiography recording. The clinical and laboratory data were compared between these groups.Results: When overall patients’ digoxin usage indications were evaluated, it was revealed that 56 patients (58.9%) had been received digoxin only for heart failure, 32 patients (33.6%) only for atrial fibrillation and 20 patients (21%) received digoxin for both conditions. The exact reason for digoxin usage could not be determined in 17 patients (17.9%). When patients were evaluated, no differences in age, gender, medical history other than coronary artery disease and laboratory findings were observed between toxic and nontoxic patients. The medical history of coronary artery disease in toxic patients was significantly higher than in nontoxic patients (p: 0.008). In these variable, no differences were observed except atrial fibrillation (p&lt;0.001), between toxic and nontoxic patients.Conclusion: In this study, the exact reasons for digoxin use could not be determined in 17 (17.9%) patients. In appropriate usage of digoxin could be increased risk of adverse outcomes and education program may reduce in appropriate use. Clinicians should be aware that signs of toxicity may occur at levels below of the 2.0 ng/mL, and such toxicity is more likely in the presence of atrial fibrillation or coronary artery disease.Keywords: Digoxin, toxicity, intoxication, serum digoxin level

In-Hospital and long term results of primary angioplasty and medical therapy in nonagenarian patients with acute myocardial infarction

Introduction: Although percutaneous coronary intervention is an accepted "first-line" therapy in acute ST elevation myocardial infarction (STEMI) in general population, few data are available on the short- and long-term outcomes of very old patients (age >90 years). Our aim is to evaluate and compare the short and long-term outcomes after primary percutaneous coronary intervention (PPCI) or medical therapy in nonagenarian patients with STEMI. Methods: We retrospectively identified patients older than 90 years old in our clinic, with acute STEMI who presented within 12 hours after symptoms onset, either underwent PPCI or medically treated. In hospital events and long-term results analyzed subsequently. Results: From January 2005 to December 2014, 73 patients with STEMI either underwent PPCI (PPCI group n = 42) or had only medical treatment (Non-PPCI group n = 31). Mean age was 92.4 ±  3.1 (90-106). Patients were followed 26.5 ± 20.1 months. Recurrent myocardial infarction during hospitalization was not observed in both groups. In-hospital mortality, cerebrovascular events and acute renal failure rate were similar between two groups (respectively P = 0.797 and P = 1.000, P = 0.288), whereas arrhythmia was significantly higher in the PPCI group ( 0; 21.4%, P = 0.009). Results show re-infarction was similar in both groups (respectively 3.2%; 11.9%, P = 0.382) but mortality in long-term was significantly lower in the PPCI group (respectively 40.9%; 12.9%, P = 0.02). Conclusion: In nonagenarian patients, with STEMI mortality is very high. Although; in-hospital events were similar, the long-term mortality rate was significantly lower in patients treated with PPCI