The interaction between endothelin-1 and C-reactive protein and their impact on long-term prognosis after percutaneous coronary interventions

WOS: 000267405600008Introduction: Previous studies have demonstrated unfavourable outcomes in coronary artery disease and percutaneous coronary intervention (PCI) patients with high endothelin-1 (ET-1) or high sensitivity C-reactive protein (hs-CRP) levels. The aim of our study was to investigate the impact of pre-procedural ET-1 and hs-CRP levels on major adverse coronary events (MACE) after PCI and to analyse a possible correlation between ET-1 and hs-CRP in this study population. Material and methods: Eighty consecutive PCI patients with a single de novo, non-occlusive coronary lesion were included. Blood samples were obtained immediately before the procedure. The study endpoint was the occurrence of MACE, which was defined as death (all causes), non-fatal myocardial infarction or repeat coronary revascularization (PCI or surgery). Results: At the end of the 24 months' follow-up, 28 patients (35%) reached an end-point. We could not observe any correlation between ET-1 and hs-CRP in the overall patient group (r = 0.141, p = 0.213). Neither ET-1 nor hs-CRP levels were found to be predictive for MACE after PCI in multivariate analyses (p = 0.605 and 0.757 respectively). Conclusions: We could not demonstrate a relationship between pre-procedural ET-1 or hs-CRP levels and MACE at 24 months after successful PCI with single stent implantation to single de novo lesions. This study also could not show any correlation between ET-1 and hs-CRP levels in PCI patients

Evaluation of Subdinical Right Ventricular Dysfunction in Obstructive Sleep Apnea Patients Using Velocity Vector Imaging

WOS: 000274099300020PubMed ID: 20009388Background: The aims of this study were to evaluate subclinical regional right ventricular (RV) dysfunction in newly diagnosed obstructive sleep apnea (OSA) patients without systemic and pulmonary arterial (PA) hypertension, and to correlate OSA severity to RV dysfunction, using both velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI). Methods and Results: The OSA group consisted of 27 patients and the control group consisted of 26 healthy participants. All participants underwent 24-h ambulatory blood pressure monitoring. Peak systolic myocardial velocities, strain, and strain rate (SR) were determined at the basal and mid segments of the RV free wall by VVI. Additionally, RV myocardial velocities were assessed by pulsed-wave TDI. Patients with OSA had significantly impaired VVI-derived peak systolic myocardial velocities, strain, and SR (P<0.0001 for all). RV isovolumic acceleration (IVA) was the only TDI-derived parameter that was significantly impaired (P<0.0001). RV IVA (r=-0.512, P<0.0001), RV mid free wall strain (r=0.568, P<0.0001) and SIR (r=0.519, P<0.0001) revealed the best correlations with apnea hypopnea index (AHI). Conclusions: Subclinical RV dysfunction is present in OSA patients despite normal systemic and PA pressures. Tissue Doppler-derived RV IVA and VVI-derived RV deformation can accurately recognize and quantify RV function abnormalities in this subgroup of patients. (Circ J 2010; 74: 312-319

A Survival Case of Painless Chronic Type A Aortic Dissection with a History of Stroke and Anticoagulant Use

WOS: 000282110700012PubMed ID: 20872939We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. Physical examination found a diastolic murmur at the left sternal border and a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection with extension into the internal right carotid artery and severe aortic regurgitation. Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy. (C) 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:454-456, 2010; Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jcu.2070

The effects of phase II cardiac rehabilitation programme on patients undergone coronary bypass surgery

Ama?: Koroner arter cerrahisi ge?iren 52 hastaya uygulanan Faz II kardiyak rehabilitasyonun etkilerini ara?t?rmakt?r. Y?ntemler: Faz II kardiyak rehabilitasyona al?nan hastalara bu program ?ncesinde ve sonunda; dereceli y?r?me testleri, kalp-akci?er kapasite testleri, lipid profili yap?ld?. Programa uygun olarak 12 hafta boyunca haftada 3 kez 20 dakika s?reli seanslar ?eklinde, 12 kanal elektrokardiyografi kontrol?nde ko?u band?nda egzersiz antrenmanlar? yap?ld?. Hastalara d???k veya orta yo?unluklu egzersiz program? verildi. Rehabilitasyon s?resince Cleveland Clinic Chronotropic Assessment egzersiz protokolu uyguland?. Bulgular: Koroner baypas operasyonu ge?irmi? 52 hastaya uygulanan Faz II kardiyak rehabilitasyon sonunda hastalar?n efor kapasitesi, oksijen t?ketimi, anaerobik e?ik, kalp debisi ortalama de?erlerinde anlaml? artma (p?0.001), HDL-kolesterol ortalama de?erinde anlaml? artma (p?0.05) ve beden kitle indeksi (BK?), total-kolesterol, LDL-kolesterol, trigliserid ortalama rakamlar?nda anlaml? azalma (p?0,001) tespit edildi. Sonu?: Koroner arter cerrahisi ge?iren hastalarda Faz II kardiyak rehabilitasyon, ya?am kalitesi ve ikincil korunma a??s?ndan ?ok yararl? bir programd?r.Objective: To investigate the effects of phase II cardiac rehabilitation in 52 patients undergone coronary artery bypass surgery. Methods: Gradual walking tests, cardio-pulmonary capacity tests and lipid profile were administered to patients selected for phase II cardiac rehabilitation before and after the programme. Training was started on 12-channel electrocardiogram controlled running bands 3 times a week for 20 min periods for 12 weeks fitting the programme. Low or intermediate level exercise programme was applied to patients. Cleveland Clinic Chronotropic Assessment exercise protocol was used during rehabilitation. Results: As a result of phase II cardiac rehabilitation administered to 52 patients undergone coronary bypass operation, exercise capacity, oxygen consumption, anaerobic threshold, cardiac output mean values (p?0.001) and mean HDL cholesterol level (p?0.05) were found to increase, whereas body mass index, total cholesterol, LDL cholesterol and triglyceride mean levels reduced (p?0.001) significantly. Conclusion: In patients who have undergone coronary bypass surgery, phase II cardiac rehabilitation is a very useful programme in improvement of life quality and secondary prevention

Response to the Letter to the Editor: "The correct number of double right coronary artery reported in the literature"

WOS: 000269156200015PubMed ID: 19073355

Subclinical Left Ventricular Dysfunction in Asymptomatic Severe Aortic Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging Study

WOS: 000275757300008PubMed ID: 20486957Objectives: Our aim was to evaluate subclinical left ventricular (LV) dysfunction, by two novel echocardiographic techniques, velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI), in patients with asymptomatic, severe aortic regurgitation (AR). Methods: Forty patients with severe AR with normal ejection fraction and 30 controls were included to the study. All patients underwent a standard echocardiography extended with TDI and VVI analyses. To evaluate the LV longitudinal and circumferential deformation, segmental systolic peak strain and strain rate (SRs) data were acquired from parasternal short axis, apical four-chamber, two-chamber, and long axis views, and additionally LV myocardial velocities, isovolumic myocardial acceleration (IVA), peak systolic velocity (Sa) and peak myocardial velocity during isovolumic contraction (IVV) assessed by TDI. Results: IVA was the only TDI-derived parameter which was significantly impaired in AR patients (P = 0.0001). Both longitudinal and circumferential strain and SRs of the LV were significantly decreased in patients with severe AR (P = 0.0001). Longitudinal and circumferential strain/SRs and TDI-derived LV IVA were inversely correlated with LV end-diastolic diameter (P = 0.0001) and end-systolic diameter (P = 0.0001). TDI-derived IVA was also very well correlated with longitudinal deformation parameters (P = 0.0001). Conclusions: VVI- derived strain imaging and TDI-derived IVA may be used as adjunctive, reliable, noninvasive parameters for evaluating subclinical ventricular dysfunction in patients with chronic, severe AR. This may help to identify patients for closer follow-up and to determine the need for surgery before developing irreversible, severe heart failure. (Echocardiography 2010;27:260-268)

Left Ventricular Pseudoaneurysm Complicating Inferior Myocardial Infarction: A Case Report

Acquired pseudoaneurysm of the left ventricle is a very rare disorder and mostly occurs after large transmural myocardial infarction (MI) with peak creatine phosphokinase-MB levels greater than 150 IU/mL. Patients developing left ventricular (LV) pseudoaneurysm usually present with angina or heart failure symptoms. Although different imaging modalities exist, coronary angiography is the gold standard for diagnosis. Surgery is the treatment of choice for LV pseudoaneurysms detected in the first months after MI. Here we report the case of a 74-year-old woman who presented with a relatively small inferior MI due to right coronary artery occlusion and complicated by LV pseudoaneurysm

Aneurysm of the membranous septum detected during left ventriculography and demonstrated by cardiac magnetic resonance imaging

WOS: 000268628100029PubMed ID: 18674835

The influence of aspirin resistance on non-fatal coronary events following percutaneous coronary interventions

WOS: 000274068200007Introduction: Aspirin resistance is associated with unfavourable prognosis, including a higher incidence of myocardial infarction, stroke, and cardiovascular death among stable cardiovascular patients, a higher incidence of re-occlusion after peripheral angioplasty, and myonecrosis following elective percutaneous coronary interventions (PCI). The objective of this study was to evaluate the relationship between aspirin resistance and non-fatal clinical endpoints during the long term follow-up following successful PCI, Material and methods: A total of 100 subjects with angiographically diagnosed coronary artery disease and treated with elective, non-urgent intracoronary stent implantation between October 2001 and June 2002 were enrolled in the study. All patients were under regular aspirin (300 mg) treatment. PFA-100 analyzer was used to assess the platelet functions. Aspirin resistance was defined as a collagen/epinephrine closure time (CTCEPI) < 186 s. The study end-point was the composite of non-fatal coronary events which included non-fatal MI, coronary artery bypass graft surgery (CABG) or repeat PCI, during the 2-year follow-up period after the index PCL Results: The incidence of aspirin resistance was found to be significantly higher (p = 0.021) in patients with non-fatal coronary events (22.4%) compared to those who did not have (5.9%). Aspirin resistance was found to be an independent risk factor for non-fatal coronary events after adjusted for other potential risk factors (p = 0.019). Conclusions: Despite regular treatment with aspirin, the incidence of aspirin resistance was significantly higher in patients who developed non-fatal coronary events on long term follow-up following elective PCI. Thus, these findings suggest that aspirin resistance might be an important risk factor that could affect the outcome following PCIs

Preoperative Left Atrial Mechanical Dysfunction Predicts Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Operation - A Velocity Vector Imaging-Based Study -

WOS: 000282562300017PubMed ID: 20818132Background: The aim of the present study was to evaluate pre-existent subclinical mechanical atrial dysfunction in patients with postoperative atrial fibrillation (POAF) by using novel echocardiographic techniques. Methods and Results: Ninety-six patients with sinus rhythm, undergoing coronary artery bypass graft (CABG) operation were prospectively enrolled. Preoperative left atrial (LA) reservoir, conduit and booster functions were evaluated by 3 different methods: conventional echocardiography, tissue Doppler imaging (TDI), and 2-dimensional strain imaging based-velocity vector imaging (VVI). POAF occurred in 25 out of 96 patients (26%). LA volume index (LAVI) was the only conventional parameter associated with POAF. TDI-derived LA velocities were similar in study groups. In VVI analysis, LA systolic strain, strain rate (SRs) and early diastolic strain rate (ESRd) were impaired in patients who developed POAF after CABG (P=0.0001). Age, LAVI, LA peak systolic strain, SRs and ESRd were found to be the independent predictors of POAF. The optimal cut-off point of 44.0% (88.7% sensitivity, 96% specificity) for LA strain, 1.7s(-1) (88% sensitivity, 86.2% specificity) for SRs and 1.95s(-1) (sensitivity 72%, 70.4% specificity) for ESRd predicted POAF in this study. Conclusions: VVI-derived strain imaging could be used as an adjunctive non-invasive method for evaluating subclinical atrial mechanical dysfunction in patients undergoing CABG. This might help us to identify patients with high risk of POAF in clinical practice. (Circ J 2010; 74: 2109-2117