Relation Between Leukocytosıs and Myocardial Performance Index in Patients With a First Acute Anterior Myocardial Infarction

Inflammation associated with acute myocardial infarction is frequentlymarked by a peripheral leukocytosis and relative neutrophilia. The objective ofthis study was to examine the association between hospital admissionperipheral total leukocyte count and the left ventricular myocardialperformance index (MPI) in patients with a first acute anterior myocardialinfarction (AMI).The subjects were 129 patients (104 men, 25 women, 59±12 years) with afirst acute AMI. We recorded admission total leukocyte count in the periphericwhole blood. Echocardiograms were used to determine left ventricular MPIwithin 24 hours after the onset of AMI.Left ventricular MPI was greater than 0.45, 89% of the patients who haveleukocytosis (Group 1, n=92). However, left ventricular MPI was lower than0.45, only 11% of the patients who have leukocytosis (Group 2, n=37) Leftventricular MPI was significantly higher group 1 patients than group 2 patients(p<0.05).Leukocytosis on admission to the hospital in patients with acute AMI issignificantly associated with higher MPI and the early development of CHF

The role of the Syndrome X in the pathophysiology of sleep-apnea syndrome

Objective: Syndrome X or microvascular angina pectoris is defined as angina pectoris due to coronary microvascular dysfunction in patients with non-stenotik epicardial arteries. The aim of his study was to investigate the relationship between obstructive sleep apnea syndrome (OSAS) and syndrome X.Materials and methods: Twenty patients (11 male, 9 female) with the complaint of chest pain who referred to Cardiology Clinics of Dicle University were enrolled in the study as Group 1. All of the patients’ exercise tests were positive, epicardial coronary arteries were normal and coronary flows were slow in Group 1. Thirty healthy person were enrolled in the study as group 2. Polysomnography (PSG) and echocardiography (ECHO) was performed in all patients.Results: In Group 1, 11 (55%) patients had obstructive sleep apnea. In Group 2, three patients (10%) had OSAS. There were significant differences in terms of OSAS frequency among groups. There were no significant differences in terms of left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), stroke volume, deceleration time (DT) , ejection time (ET) and the left atrium (LA) diameter between Syndrome X and control groups according to echocardiographic examination (p>0.05). However, IVRT, RA diameter, the myocardial performance index (MPI), PAP, and MEV / mav rates were significantly different (p <0.05).Conclusion: OSAS -also known to cause cardiovascular complications- incidence was significantly higher in patients with syndrome X than the healthy subjects. In OSAS patients, apnea hypopnea index, cardiovascular risk factors such as hypertension and dyslipidemia were more common than healthy subjects. Therefore, these patients should be followed up closely and be treated properly

Comparison of right ventricular functions according to infarct localization using advanced echocardiographic methods in myocardial infarction with ST elevation

Objectives: In this study, we aimed to compare the effectsof infarct localization in patients with ST ElevatedMyocardial Infarction (STEMI) on the right ventricular(RV) functions by using advanced echocardiographicmethods.Materials and methods: A total of 89 patients withSTEMI were included into the study and patients weredivided to three groups as anterior, isolated-inferior andinferior+RV MI groups. In addition to standard echocardiographicmesurements, RV tissue doppler, RV EjectionFraction (RVEF), Myocardial performance index (MPI)and TAPSE measurements of all patients were performedbetween 24-72 hours after the event.Results: Compared to groups, RV functions in inferior MIwith RV involvement group were deteriorated. Tricuspidannular plane systolic excursion (TAPSE) value for theinferior MI with RV involvement (19±1mm) group werelower than those for Inferior MI group without RV involvement(23±1mm) and anterior MI (23±1mm) (p<0.05). TheRV MPI value for inferior MI group with RV involvement(0.76±0.14) were found to be higher than those for anterior(0.64±0.1) and inferior MI (0.56±0.1) group withoutRV involvement (p<0.05). Peak Sm (r = -0.35, p =0.01), TAPSE (r = -0.47, p<0.001) and RV EF (r = -0.46,p<0.001) showed a negative correlation with RV MPI value.Furthermore, RV tricuspid E/A rate (r = -0.19, p = 0.7)and RV free wall tissue doppler Em/Am rate (r = -0.26, p =0.01) displayed a negative correlation with RV MPI value.Conclusions: Use of advanced methods addition to theconventional echocardiographic methods in STEMI patients,could produce more valuable information to evaluateRV functions and provide a positive impact on treatmentstrategies.Key words: Acute myocardial infarction, right ventricle,echocardiography, TAPSE, MP

Current diagnosis and treatment in pulmonary thromboembolism

Pulmonary thromboembolism (PTE), is usually a complicationof deep vein thrombosis (DVT). Pulmonary thromboembolismdevelops as a result of obstruction of pulmonaryartery and / or branches with pieces that rupturedfrom the deep vein thrombosis of the leg. Pulmonarythromboembolism and DVT is also referred as venousthromboembolism (VTE) because of two events often remaintogether. The true incidence is uncertain because ofmore than half of the patients can be lost before the diagnosis.Despite the many new developments in the lastdecade on the diagnosis and treatment, PTE is still one ofthe difficult to diagnose and fatal diseases of lungs. Classicaland contemporary approaches to the diagnosis andtreatment of PTE were evaluated together in this review.J Clin Exp Invest 2013; 4 (3): 405-410Key words: Pulmonary, thromboembolism, diagnosis,treatmen

Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction.Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution.Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001). On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179)Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome

Elastic properties of the aorta and factors affecting aortic stiffness in patients with

Objectives: In this study, we evaluated aortic stiffnessand echocardiographic and laboratory factors affectingaortic stiffness in patients with metabolic syndrome(MetS).Materials and methods: Forty-six patients (25 male,mean age 47.3±6.5 years) with the diagnosis of MetS accordingto the Adult Treatment Panel III Final Report criteriawere included. Forty-four age and gender matchedhealthy subjects (18 male, mean age 46.0±6.1 years)were recruited as the control group. Aortic strain, distensibilityand stiffness index were calculated by M-modeechocardiography and diastolic parameters were measured.Results: Left ventricular mass index (LVMI), decelerationtime (DT), isovolumic relaxation time (IVRT) wereincreased and mitral E/A ratio was decreased in patientswith MetS compared to controls. In the MetS patients,aortic distensibility was significantly decreased (10.4±3.5cm2.dyn-1.10-6 vs. 12.7±3.4 cm2.dyn-1.10-6, p=0.002),and ASI was significantly increased (6.5±2.0 vs. 3.2±0.8,p<0.001). ASI was positively correlated with triglycerides,fasting glucose, uric acid, hsCRP, LVMI, DT, IVRT andsystolic blood pressure level, and was negatively correlatedwith HDL-cholesterol and mitral E/A ratio. In regressionanalysis, hsCRP (p=0.05) and systolic blood pressurelevel (p<0.001) were independent predictors of ASI.Conclusions: ASI is increased in patients with MetS. Inthese patients; decrease in aortic elasticity properties wasassociated with left ventricular diastolic dysfunction. Highsystolic pressure and hsCRP levels were found to be independentpredictors of ASI.Key words: Metabolic syndrome, Echocardiography,elastic properties of aorta, hsCR

Left atrial dimension to left ventricle ejection fraction ratio can predict longterm major adverse events ın patients with acute coronary syndrome

Background: It is critical to specify the high-risk group in acute coronary syndrome following percutaneous coronary intervention. Left atrial diameter and Left ventricle ejection fraction are functional echocardiographic parameters for risk classification thanks to easy obtainable, cheap, and non-invasive nature. However, major adverse cardiovascular events may be predicted less than actual where ejection fraction or left atrial diameter are in the normal range. We aimed to assess the left atrial diameter to ejection fraction ratio for major adverse cardiovascular events prediction in acute coronary syndrome. Materials and Methods: Individuals with acute coronary syndrome were included in the study. Atrial diameter and ejection fraction parameters were obtained at admission. The left atrial diameter to left ventricular ejection fraction ratio was calculated through atrial diameter dividing by ejection fraction, and the relationship between new-onset heart failure and all-cause mortality with this ratio was investigated for two years period. Results: The mean age of total 262 patients were 62.1±11.5 years. Thirty-nine (18.9 %) of patients were female and major adverse cardiovascular events occurred in 73 (28%) of the patients. In the backward multivariable Cox regression analysis, age [Hazard ratio (HR)=1.039, 95%CI:1.017-1.060, p<0.001], Killip class [HR=2.099, 95%CI:1.011-4.365, p=0.045], serum creatinine level [HR=2.202, 95%CI:1.247-3.811, p=0.003], and left atrial diameter to left ventricular ejection fraction ratio [HR=1.029, 95%CI:1.019-1.038, p<0.001] were revealed to be independent predictors of major adverse events. Conclusion: Left atrial diameter to left ventricular ejection fraction ratio were predictors of two years new-onset heart failure and mortality in acute coronary syndrome. This novel practical index may provide better prediction for adverse events in all patient groups.Amaç: Akut koroner sendromlu hastalarda perkütan koroner girişim sonrası yüksek riskli grupların belirlenmesi oldukça önemlidir. Sol ventrikül ejeksiyon fraksiyonu ve sol atrium çapı, kolay elde edilebilebilir, ucuz ve invaziv olmaması nedeniyle risk sınıflandırması için fonksiyonel ekokardiyografik parametrelerdir. Bununla birlikte, majör istenmeyen kardiyovasküler olaylar, ejeksiyon fraksiyonu veya atrium çapının normal aralıkta olduğu durumlarda gerçek olandan daha az tahmin edilebilir. Bu nedenle akut koroner sendrom hastalarında majör istenmeyen olay öngörüsü için sol atrium çapının sol ventrikül ejeksiyon fraksiyonuna oranının değerlendirilmesini amaçladık. Materyal ve Metod: Çalışmaya akut koroner sendrom tanısı almış hastalar dahil edildi. Tüm hastalardan sol ventrikül ejeksiyon fraksiyonu ve sol atrium çapları parametreleri başvuru sırasında elde edildi. Sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı, sol atriyal çapın ejeksiyon fraksiyonuna bölünmesi ile hesaplandı ve 2 yıllık takiplerde tüm nedenlere bağlı ölüm ve yeni başlayan kalp yetmezliği ile olan ilişkisi incelendi. Bulgular: Toplam 262 hastanın ortalama yaşı 62.1±11.5 yıldı. Hastaların 39'u (%18.9) kadındı ve major istenmeyen kardiyovasküler olay 73 (%28) hastada meydana geldi. Geriye dönük çok değişkenli Cox regresyon analizinde, yaş [Hazard ratio (HR)=1.039, 95%CI:1.017-1.060, p<0.001], Killip sınıfı [HR=2.099, 95%CI:1.011-4.365, p=0.045], serum kreatinin düzeyi [HR=2.202, 95%CI:1.247-3.811, p=0.003], ve sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı [HR=1.029, 95%CI:1.019-1.038, p<0.001] major istenmeyen olayların bağımsız prediktörleri olarak bulundu. Sonuç: Sol atrial çapın sol ventrikül ejeksiyon fraksiyonuna oranı, akut koroner sendrom hastalarında 2 yıllık yeni tanı kalp yetmezliği ve ölümün bağımsız prediktörleriydi. Bu yeni pratik index istenmeyen olayların öngörülmesi için tüm hasta gruplarında daha fazla öngörü sağlayabili