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Cardiac hepatopathy has generally been used to describe any liver damage caused by cardiac disorders in the absence of other possible causes of liver damage. Although there is no consensus on the terminology used, cardiac hepatopathy can be examined as congestive hepatopathy (CH) and acute cardiogenic liver injury (ACLI). CH is caused by passive venous congestion of the liver that generally occurs in the setting of chronic cardiac conditions such as chronic HF, constrictive pericarditis, tricuspid regurgitation, or right-sided heart failure (HF) of any cause, and ACLI is most commonly associated with acute cardiocirculatory failure resulting from acute myocardial infarction, acute decompensated HF, or myocarditis. Histologically, CH is characterized by sinusoidal dilation, replacement of hepatocytes with red blood cells extravasating from the sinusoids, and necrosis/apoptosis of zone 3 of the Rappaport acinus, and it could progress to cirrhosis in advanced cases. In ACLI, however, massive necrosis of zone 3 is the main histological finding. Primary laboratory findings of CH are elevated serum cholestasis markers including bilirubin, alkaline phosphatase, and γ-glutamyl-transpeptidase levels, whereas those of ACLI are a striking elevation in transaminase and lactate dehydrogenase levels. Both CH and ACLI have a prognostic value for identifying cardiovascular events and mortality and have some special implications in the management of patients undergoing ventricular assist device implantation or cardiac transplantation. There is no specific treatment for CH or ACLI other than treatment of the underlying cardiac disorder.

Left ventricular (LV) apical thrombus formation is a well described and clinically important complication of acute myocardial infarction (MI) with a substantial risk of thromboembolism. Alterations in the inflammatory status may contribute to this complication. The aim of this study was to evaluate the predictive role of the systemic immune-inflammation index (SII) in identifying high risk patients who will develop an apical thrombus formation during the acute phase of anterior transmural infarction. Consecutive 1753 patients (mean age: 61.5 ± 9.6 years; male: 63.8 %) with first acute anterior MI who underwent primary percutaneous coronary intervention were assessed. Patients were divided into 2 groups according to the presence of apical thrombus. SII was calculated using the following equation: neutrophil (N) × platelet (P) ÷ lymphocyte (L). LV apical thrombus was detected on transthoracic echocardiogram in 99 patients (5.6%). Patients with an apical thrombus had lower LV ejection fraction, prolonged time from symptoms to treatment, higher rate of post-percutaneous coronary intervention thrombolysis in myocardial infarction flow ≤1 and significantly higher mean high-sensitivity C-reactive protein, and SII values and lower lymphocyte than those without an apical thrombus. Admission SII level was found to be a significant predictor for early LV apical thrombus formation complicating a first-ever anterior MI. This simple calculated tool may be used to identify high-risk patients for LV thrombus and individualization of targeted therapy.

Introduction: Coronary angiography is a principle diagnostic and therapeutic procedure in modern cardiology practice. The transradial access for cardiac catheterization has overtaken the transfemoral approach because of many advantages. However, some patients suffer radial pain after the procedure. Unfortunately, this complication has been poorly evaluated in previous studies. The present study aimed to determine the prevalence of radial pain after transradial coronary angiography and investigate factors that influence post-procedural pain. Methods: This is a cross-sectional study in which a total of 100 consecutive patients who underwent elective transradial coronary angiography ± percutaneous coronary intervention between January 2015–2016 were evaluated. The patients were asked about presence of disturbing pain in the forearm especially wrist region after the procedure. Verbal rating scale was used to evaluate pain assessment. The patients were divided as early pain group (two hours after the procedure) and prolonged pain group (one month after the procedure) and analysis was performed. Results: A total of 55 patients suffered from pain in the early phase (after two hours), and 26 of patients had prolonged pain at one month after the radial intervention. Independent pain predictors in the early pain group were male operator (p = 0.004, OR = 3.386, 95% CI: 1.484–7.725) and experience of operator (OR = 4.147, 95% CI: 1.637–10.506, p = 0.003). On the other hand, the younger age of patients (OR = 0.955, 95% CI: 0.915–0.966, p = 0.032) and experience of operator (OR = 3.947, 95% CI: 1.547–10.047, p = 0.004) were the independent predictors of prolonged radial pain. Conclusion: Pain after radial coronary angiography is not uncommon. Experience, operator gender, and age of the patients were independent predictors of pain after transradial coronary angiography.

In patients with severe aortic stenosis, the data about the incidence of acquired thrombocytopenia according to the use of balloon-expandable or self-expandable valves are limited. We investigated the relationship between the post-transcatheter aortic valve replacement (TAVR) thrombocytopenia and the balloon-expandable or self-expandable valves. A total of 127 consecutive patients who underwent TAVR were retrospectively analyzed. Among the study population, 61 (48%) patients underwent TAVR with the balloon-expandable valve and the 66 (52%) patients with the self-expandable valve. Procedural success did not differ between the groups ( P = .575). The access site complications and in-hospital mortality were the same across the groups ( P = .225 and P = .466). However, paravalvular (PV) leaks were significantly higher in the self-expandable valve group ( P = .007). Among all, 65 patients experienced thrombocytopenia, which was more frequent in the self-expandable valve group (63.6 vs 37.7%, P = .005). In multivariate analyses, admission platelet count, PV leak, and self-expandable valve deployment were the predictors of thrombocytopenia ( P = .001, P = .002, and P = .021, respectively). The present study showed a higher incidence of acquired thrombocytopenia in the self-expandable valve group. Although the procedural success was similar between the groups, postprocedural PV leaks were more common in the self-expandable valve group.

Presently described is a case in which the tip of the delivery catheter system (nose cone) has been broken during catheter removal after valve deployment in a femoral transcatheter aortic valve replacement procedure and the successful management of this rare complication.

Aim: This study aims to assess the predictive role of the preprocedural circulating monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) on the occurrence of stent restenosis (SR) in patients with stable and unstable angina pectoris undergoing successful bare-metal stenting (BMS). Patients & methods: Between February 2008 and June 2014, a total of 831 patients with stable and unstable angina pectoris who underwent successful BMS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. Left ventricular ejection fraction and laboratory data were also noted. Results: In the receiver operating characteristics curve analysis, MHR >14 had 71% sensitivity and 69% specificity in predicting SR. Conclusion: Our study results show that preprocedural MHR is an independent predictor of SR in this patient population.

Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p0.001), CRP [45(13-98) vs 12(5-28), p0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF50%, vegetation size of10mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p=0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively.Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.

Background Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS. Methods Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated. Results Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG

Background Fragmented QRS complex (fQRS) is associated with cardiovascular outcomes in various patient populations. Although there were clinical studies investigating the association of fQRS with arrhythmic events in patients with systolic heart failure, the results were conflicting regarding the association of implantable cardioverter defibrillator (ICD) shocks and fQRS. In this study, we aimed to evaluate the association between the presence and extent of fQRS with appropriate ICD shocks and/or all-cause mortality. Methods A total of 215 patients (age: 58.2 ± 11.6 years, 72.5 % male) with the diagnosis of left ventricular systolic heart failure in whom ICD had been implanted for primary prophylaxis were enrolled. Standard ECG evaluation revealed fQRS complex in 123 patients (57.2 %). The phenomenon of fQRS was defined as deflections at the beginning of the QRS complex, on top of the R wave, or in the nadir of the S wave similar to the definition in CAD. Results At mean 23.5 ± 12.1 months follow-up, all-cause mortality was observed in 45 (20.9 %) patients and 111 (51.6 %) patients experienced appropriate ICD shocks. Median number of ECG leads with fQRS were higher in patients with appropriate ICD shocks (3 [2–6] vs 1 [0–2], P < 0.001, respectively). The presence of fQRS (HR: 6.64, 95 % CI: 3.54–12.4, P < 0.001) and the number of leads with fQRS (HR: 1.35, 95% CI: 1.22–1.67) were found as independent predictors of appropriate ICD shocks. Additionally, there was a negative correlation between left ventricular ejection fraction and the number of leads with fQRS (r = −0.434, P < 0.001). Rates of all-cause mortality did not differ between the fQRS(+) (29 [24 % ]) and fQRS(−) (16 [17 % ]) groups (P = 0.27). Conclusion Our findings suggest that the presence and extent of fQRS complex on standard 12-lead ECG predicts appropriate ICD shocks in patients with left ventricular systolic heart failure who underwent ICD implantation for primary prophylaxis.

Red cell distribution width (RDW) is a strong prognostic marker for systolic left heart failure regardless of the anemia status, and heart rate variability (HRV) is negatively associated with mortality and sudden cardiac death in patients with systolic left heart failure. Their relationship has not been investigated in the previous literature.One hundred eighty four patients who had been previously diagnosed with systolic left heart failure (with ischemic or non-ischemic etiology) were retrospectively enrolled in our study. Patients underwent 24-h electrocardiographic monitoring, and blood samples for RDW and other variables were analyzed. Study population was grouped into tertiles of RDW (Tertile 1: 13.4 ± 1.4%, Tertile 2: 14.6 ± 1.4%, and Tertile 3: 17.1 ± 1.2%).Most of the characteristics of patients were similar among RDW tertiles. Standard deviation of all normal RR intervals (SDNN), standard deviation of the averages of RR intervals in all 5-min segments (SDANN) and root-mean square of difference of successive RR intervals (RMSSD) values significantly differed among groups (p0.001). The highest RDW tertile had the lowest HRV values, and Pearson correlation analysis yielded a negative correlation between HRV parameters and RDW (for SDNN, SDANN, RMSSD; r = 0.373, 0.340, 0.362, respectively, p0.001 for all). In stepwise multivariate analysis HRV was independently associated with RDW.The HRV parameters were independently associated with RDW in patients with systolic left heart failure.

Aim: To determine the association of monocyte count-to-high-density lipoprotein (HDL)-cholesterol ratio, a recently emerged inflammatory marker, with abdominal aortic aneurysm (AAA) size. Patients & methods: A total of 120 asymptomatic AAA subjects (99 male, mean age: 67.1 ± 10.2 years) were enrolled into the study. All data were compared between patients with low and high admission monocyte/HDL ratio. Multivariate linear regression analysis was performed to study the relationship between different variables and AAA size. Results: Compared to patients with below-median monocyte/HDL ratio, aneurysm diameter was significantly higher in above-median monocyte/HDL ratio group (54.3 ± 10.6 mm vs 62.0 ± 12.4 mm, p < 0.001, respectively). Hypertension, coronary artery disease, monocyte/HDL ratio and C-reactive protein were independently associated with AAA diameter. Conclusion: Monocyte/HDL ratio is independently associated with AAA size.

Uric acid (UA) is independently associated with the emergence of hypertension. Nocturnal nondipping pattern of hypertension is associated with a greater risk of cardiovascular, renal, and cerebrovascular complications than dippers. The aim of the present study was to evaluate the relationship between the circadian blood pressure rhythm and UA level in patients with newly diagnosed essential hypertension. The study included 112 essential hypertensive patients and 50 healthy controls. The hypertensive patients were divided into two groups according to the results of 24-hour ambulatory blood pressure monitoring, including 60 dippers (35 men, 25 women; mean age, 52.6±15.8 years) and 52 nondippers (29 men, 23 women; mean age, 55.9±13.2 years). Nondippers had significantly higher serum UA levels than the dippers and controls (5.8±0.8, 5.1±0.9 and 4.2±0.9 mg/dL, respectively; P

Amac: Metabolik sendromda aortik sertlikte artis olmasi beklenmektedir. Calismamizda metabolik sendrom (MetS)\'lu hastalarda aortik sertlik ve bununla iliskili ekokardiyografik ve biyokimyasal parametreleri saptamayi amacladik. Gerec ve yontem: Calismaya guncellenmis ATP III kriterlerine gore MetS tanisi alan ardisik 46 hasta (25 erkek, ortalama yas 47.3±6.6 yil) ve 44 kontrol (18 erkek, ortalama yas 46.0±6.1yil) hastasi alindi. M-mode ekokardiyografi ile aortik strain, distensibilite ve sertlik indeksi hesaplandi. Ekokardiyografik olarak diastolik parametrelerin olcumu yapildi. Bulgular: Ekokardiyografik parametrelerden sol ventrikul kitle indeksi, deselerasyon zamani (DZ), izovolumetrik relaksasyon zamani (IVRZ) MetS\'lu hastalarda kontrol grubuna kiyasla yuksek ve mitral E/A orani ise dusuk saptandi. MetS\'lu hastalarda kontrol grubuna kiyasla aortik distensibilite anlamli dusuk (10.4±3.5\'e cm2.dyn-1.10-6 karsilik 12.7±3.4 cm2.dyn-1.10-6, p=0.002), sertlik indeksi ise anlamli yuksek saptandi (6.5±2.0\'e karsilik 3.2±0.8, p

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

OBJECTIVES We aimed to determine the in-hospital mortality and clinical outcome of patients older than 75 years who were admitted to our high-volume tertiary center with ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous intervention (PCI). STUDY DESIGN Our study included patients over 75 years old who were admitted with STEMI and underwent primary PCI at our center between January 2008 and September 2011. We retrospectively collected data from our hospital records for 1165 patients with STEMI. We found 186 patients that were eligible for our study. We defined major adverse cardiovascular events (MACE) as in-hospital mortality, repeated target vessel revascularization, and reinfarction. RESULTS The mean age of the patients was 79.7±4.4 years and the mean pain-balloon inflation time was 4.7±2.3 hours. The procedure success rate was 71.5%. In-hospital mortality and MACE occurred in 20.4% and 25.8% of patients, respectively. Twenty patients had cardiogenic shock at admission. Patients with cardiogenic shock had significantly more MACE than the rest of the study population (76.5% vs. 17.5%, p

OBJECTIVES Epicardial fat tissue is a type of visceral adipose tissue that functions as a metabolically active endocrine organ. Most components of metabolic syndrome (MetS), especially visceral obesity, are associated with a low-grade systemic inflammatory state. In this study, we aimed to assess the relationship between echocardiographic epicardial fat thickness (EFT), MetS, the components of MetS, and high sensitivity C-reactive protein (hs-CRP) levels in patients with MetS. STUDY DESIGN Forty-six patients (25 males, mean age 47.3±6.5 years) with the diagnosis of MetS (according to the Adult Treatment Panel III update criteria) but without clinical coronary artery disease, and 44 age and gender matched healthy volunteers (18 males, mean age 46.0±6.1 years) were included in the study. EFT, which was measured by transthoracic echocardiography, as well as clinical and biochemical parameters were compared between the two groups. RESULTS Waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressure levels, hs-CRP, and uric acid levels were significantly higher in patients with MetS. EFT was also significantly increased in patients with MetS (8.7±0.2 mm vs. 4.8±0.1 mm, p

Serum uric acid (UA) is independently associated with hypertension and blood pressure (BP) variability (BPV) is associated with cardiovascular events and mortality in hypertensive patients. The aim of the present study was to assess the association of serum UA with BPV in 300 untreated essential hypertension patients (mean age 57.3±13.6 years). BPV was quantified as the standard deviation (SD) of the 24-hour, daytime, and nighttime mean values obtained by using ambulatory BP monitoring. In correlation analysis, log UA values were found to be positively correlated with 24-hour systolic BPV and nighttime systolic and diastolic BPV (Pearson coefficients of 0.246, 0.280, and 0.353, respectively; P

Summary Elevated serum bilirubin concentrations protect from atherosclerotic diseases; however, it is not clear whether higher serum bilirubin concentrations in physiological ranges do the same. To investigate the association of high and low serum bilirubin concentrations with left ventricular diastolic function and aortic elastic properties. We evaluated left ventricular diastolic function and aortic elastic properties of 42 healthy subjects with hypobilirubinemia (total bilirubin 0.40 ± 0.08 mg/dl; mean age 37.0 ± 3.9) and 40 healthy subjects with hyperbilirubinemia (total bilirubin 1.56 ± 0.49 mg/dl; mean age 36.2 ± 6.0) using transthoracic second harmonic Doppler echocardiography. Age, gender, body mass index and coronary risk factors were similar between the groups, except high-sensitivity C-reactive protein (hsCRP). Left ventricular diastolic parameters were similar between the two groups. Aortic distensibility (AoD) was found to be significantly lower (11.1 ± 3.9 vs. 13.2 ± 4.9, p = 0.03) and aortic stiffness index (AoSI) (1.99 ± 0.30 vs. 1.85 ± 0.26, p = 0.02) and elastic modulus (AoEM) (2.06 ± 0.83 vs. 1.73 ± 0.68, p = 0.03; the low and high bilirubin groups, respectively) higher in the low bilirubin group. Serum total bilirubin concentration correlated with hsCRP levels, AoD, AoSI and AoEM. In conclusion, left ventricular systolic and diastolic functions were similar between hypo- and hyperbilirubinemic subjects, but aortic elastic properties were impaired in subjects with lower serum bilirubin concentrations.

Objectives: To assess the possible influence of white-coat hypertension (WCH) on coronary flow reserve (CFR). Methods: CFR was measured by means of transthoracic second harmonic Doppler echocardiography in 29 patients with WCH, 32 patients with sustained hypertension and 35 healthy volunteers. Results: CFR was significantly lower in the sustained hypertension group than in the WCH and the control groups, but it was not different between the WCH and the control groups (2.40 (SD 0.54), 2.77 (0.41) and 2.83 (0.60), respectively). Conclusion: CFR is preserved in patients with WCH.

Elevated levels of low-density lipoprotein (LDL) cholesterol and its oxidative modification have been described to be involved in the process of atherogenesis. Bilirubin, an antioxidant, prevents oxidative modification of LDL and therefore may protect from atherosclerosis and coronary heart disease (CHD). Impaired brachial artery flow-mediated dilatation (FMD), which means endothelial dysfunction (ED) and carotid intima-media thickness (IMT) are predictors for the development and progression of atherosclerosis. In the present study, FMD and IMT were studied in healthy subjects with lower and higher serum bilirubin concentrations in physiological ranges.Ninety-one healthy subjects between 25 and 45 years of age (47 with lower and 44 with higher serum bilirubin concentrations) were included in this study. Carotid IMT and brachial artery flow-mediated dilatation was measured by means of high-resolution vascular ultrasound. FMD was assessed by establishing reactive hyperemia and endothelium-independent dilatation (EID) was determined by using sublingual isosorbide dinitrate.EDD in subjects with lower serum bilirubin concentrations was significantly worse than in those with higher serum bilirubin concentrations (11.6+/-4.4% versus 7.2+/-4.7%, respectively, p0.0001). EID measurements were not significantly different between the groups (16+/-5.1% versus 16.8+/-7%, respectively). In addition, carotid IMT was significantly greater in subjects with lower serum bilirubin concentrations (0.5+/-0.13 mm versus 0.42+/-0.07 mm, p0.0001). Furthermore, FMD in women with lower serum bilirubin concentrations was significantly lower than in women with higher serum bilirubin concentrations (11.5+/-4.9% and 17.5+/-4.7%, respectively, p0.001). Accordingly, men with lower serum bilirubin concentrations had significantly lower FMD as compared to hyperbilirubinemic ones (11.7+/-3.6% versus 16.7+/-4.8%, respectively, p=0.009). Conversely, carotid IMT was significantly greater in both women and men with lower serum bilirubin concentrations compared to the subjects with elevated serum bilirubin concentrations (0.51+/-0.08 versus 0.41+/-0.08, p0.001; 0.55+/-0.12 versus 0.40+/-0.07, p=0.002, in women and men, respectively).The healthy subjects with lower serum bilirubin concentrations show significant ED and increased carotid IMT, which are predictors for atherosclerosis.

BACKGROUND It is thought that women with polycystic ovary syndrome (PCOS) are at increased risk of developing cardiovascular diseases. METHODS In this study, we used transthoracic echocardiography to measure coronary flow reserve (CFR) in 28 women with PCOS and in 26 healthy women. RESULTS The PCOS and the control groups were similar in terms of age (27.1 +/- 4.5 versus 28.8 +/- 4.4 years) and BMI (26.6 +/- 5.7 versus 24.7 +/- 4.4 kg/m2). Fasting insulin levels and homeostasis model assessment insulin resistance index were higher in the PCOS group. LH, the LH/FSH ratio, total testosterone, free testosterone and androstenedione were higher in the PCOS group. FSH, estradiol, prolactin, progesterone, cholesterol, triglyceride and high-sensitive C-reactive protein were similar between the two groups, but homocysteine levels were higher in the PCOS group. Baseline diastolic peak f low velocity (DPFV) (25.0 +/- 4.6 versus 23.3 +/- 2.7 cm/s, P > 0.05), hyperaemic DPFV (71.2 +/- 12.8 versus 73.0 +/- 12.9 cm/s, P > 0.05) and CFR (2.8 +/- 0.8 versus 3.2 +/- 0.8 cm/s, P > 0.05) of the left anterior descending coronary artery were similar between the two groups. CONCLUSION We conclude that in young women with PCOS and without cardiovascular risk factors, CFR is preserved.

Background: Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. In this study, CFR of hemodialysis patients with angiographically normal coronary arteries was evaluated using transthoracic second harmonic Doppler echocardiography. Methods and Results: Ten hemodialysis patients, and 14 sex-, age- and left ventricular mass index-matched hypertensive controls with angiographically normal coronary arteries underwent transthoracic second harmonic Doppler echocardiographic examination. Coronary basal diastolic peak flow velocities and hyperemic peak flow velocities after dipyridamole infusion (0.56 mg/kg over 4 min) were measured. CFR was defined as the ratio of hyperemic to basal diastolic peak velocities. CFR ≧2.0 was regarded as normal. Additionally, Doppler tissue imaging pulse wave measurements were taken from the lateral and septal corners of the mitral annulus. CFR values were significantly lower in the study group than in the control group (2.03 ± 0.3 vs. 2.61 ± 0.5, p = 0.005). In 5 of 10 hemodialysis patients, CFR was Conclusions: Impairment of coronary microvasculature occurs earlier in patients with chronic renal failure and may be the harbinger of subsequent primary uremic myocardial disease. In patients with chronic renal failure and normal coronary arteries, decreased CFR by transthoracic echocardiography might be regarded as an early finding of an affected coronary vasculature.

The most common causes of coronary artery aneurysm are atherosclerosis and Kawasaki disease. The disorder is frequently associated with severe multivessel atherosclerotic disease. If the aneurysm is associated with significant coronary artery disease and is leading recurrent ischemia, surgery should be considered. However, the surgery to be performed is not well established and largely depends on the shape of the aneurysm and the preference of the surgeon. We report a case of coronary artery aneurysm due to poststenotic dilation, located at the bifurcation point of the left anterior descending artery and the circumflex artery treated surgically.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with cardiovascular outcomes in various patient populations. Although there were clinical studies investigating the association of fQRS with arrhythmic events in patients with systolic heart failure, the results were conflicting regarding the association of implantable cardioverter defibrillator (ICD) shocks and fQRS. In this study, we aimed to evaluate the association between the presence and extent of fQRS with appropriate ICD shocks and/or all‐cause mortality. METHODS: A total of 215 patients (age: 58.2 ± 11.6 years, 72.5 % male) with the diagnosis of left ventricular systolic heart failure in whom ICD had been implanted for primary prophylaxis were enrolled. Standard ECG evaluation revealed fQRS complex in 123 patients (57.2 %). The phenomenon of fQRS was defined as deflections at the beginning of the QRS complex, on top of the R wave, or in the nadir of the S wave similar to the definition in CAD. RESULTS: At mean 23.5 ± 12.1 months follow‐up, all‐cause mortality was observed in 45 (20.9 %) patients and 111 (51.6 %) patients experienced appropriate ICD shocks. Median number of ECG leads with fQRS were higher in patients with appropriate ICD shocks (3 [2–6] vs 1 [0–2], P < 0.001, respectively). The presence of fQRS (HR: 6.64, 95 % CI: 3.54–12.4, P < 0.001) and the number of leads with fQRS (HR: 1.35, 95% CI: 1.22–1.67) were found as independent predictors of appropriate ICD shocks. Additionally, there was a negative correlation between left ventricular ejection fraction and the number of leads with fQRS (r = −0.434, P < 0.001). Rates of all‐cause mortality did not differ between the fQRS(+) (29 [24 % ]) and fQRS(−) (16 [17 % ]) groups (P = 0.27). CONCLUSION: Our findings suggest that the presence and extent of fQRS complex on standard 12‐lead ECG predicts appropriate ICD shocks in patients with left ventricular systolic heart failure who underwent ICD implantation for primary prophylaxis.

We hypothesised that increased on-admission and follow-up mean platelet volume (MPV) levels would correlate with adverse outcomes in patients with infective endocarditis (IE). A total of 108 consecutive patients were grouped into two according to median MPV level (≤ 8.6 and > 8.6 fL). Patients with MPV level of > 8.6 fL had a significantly higher rate of end-stage renal disease, Staphylococcus aureus infection, higher CRP levels, embolic events and in-hospital mortality compared to patients with MPV levels ≤ 8.6 fL. In multivariable Cox regression analysis, previous history of IE, S. aureus infection, end-stage renal disease, depressed LVEF, early surgical intervention, vegetation size ≥ 10 mm, presence of perivalvular abscess, higher on-admission platelet count, CRP and MPV levels emerged as independent predictors of in-hospital unfavourable outcomes. Patients with embolic events and in-hospital mortality revealed an incremental trend for MPV levels compared to patients without any adverse events. Our study results suggest that both on-admission and follow-up MPV levels may be a simple and available biomarker for risk stratification of IE patients.

In patients with idiopathic dilated cardiomyopathy (IDC), attenuated coronary flow reserve (CFR) and elevated serum uric acid levels have been reported. In this study, we investigated whether increased uric acid levels correlate with the degree of coronary microvascular dysfunction. Serum uric acid levels were measured in 29 patients with IDC (mean age: 57.0±10.8 years, 10 female), and each patient also underwent transthoracic echocardiographic examination including CFR measurement. The study population was divided into two groups according to the median CFR value (lower CFR group and higher CFR group). Uric acid levels were significantly higher in the lower CFR group than in the higher CFR group (7.59±2.56 vs 4.80±0.80 mg/dL, P=0.000). CFR correlated significantly and inversely to serum uric acid (r=–0.570, P=0.001). Logistic regression analysis revealed that uric acid level was the only independent predictor of CFR (B=–1080, P=0.015). We found a possibly clinically important negative association between serum uric acid levels and CFR in patients with IDC.

Angiosarcoma, the most common primary malignant neoplasm of the heart in adults, usually presents as pericardial effusion or right-sided heart failure. Rupture of an angiosarcoma-infiltrated cardiac chamber as a cause of hemothorax is very rare in the literature. In this report, we describe a 34-year-old male patient, who presented to emergency service with sudden chest pain and dyspnea. The diagnostic work-up revealed spontaneous right-sided hemothorax and a large right atrial (RA) mass with suspicious atrial perforation. An urgent surgery showed a vascularized irregular RA mass invading the parietal pericardium and pleura and a perforation of the RA free wall. Histopathologic examination confirmed the diagnosis of angiosarcoma, and the patient was subsequently referred for radiotherapy and chemotherapy.

Background Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS. Methods Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated. Results Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG

Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Aortic stiffness (AS) is a simple and effective method for assessing arterial elasticity. The aim of this study was to evaluate whether there is an independent association of impaired coronary flow and aortic elasticity in patients with MetS.Forty-six patients (mean age 47.3 ± 6.6 years) with the diagnosis of MetS according to the ATP III update criteria and 44 age and gender matched controls (mean age 46.0 ± 6.1 years) were included into the cross-sectional observational study. Peak diastolic coronary flow velocities were measured in left anterior descending artery by pulsed wave Doppler at baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Aortic strain, distensibility and stiffness were calculated by M-mode echocardiography. Statistical analysis was performed by using Student t-test, Chi-square test, Pearson correlation and linear regression analyses.CFR was significantly lower in patients with MetS than in controls (2.3 ± 0.2 vs 2.7 ± 0.2, p0.001). In the MetS group, aortic distensibility (10.4 ± 3.5 cm².dyn⁻¹.10⁻⁶ vs. 12.7 ± 3.4 cm2.dyn⁻¹.10⁻⁶, p=0.002) was decreased and AS was significantly increased (6.5 ± 2.0 vs. 3.2 ± 0.8, p0.001). In multivariate linear regression analysis, AS (β=-0.217, p=0.047), systolic blood pressure (β=-0.215, p=0.050) and waist circumference (β=-0.272, p=0.012) had an independent relationship with impaired CFR.This study demonstrated that coronary flow reserve is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness, systolic blood pressure or waist circumference.AMAÇ: Metabolik sendrom (MetS) kardiyovasküler olayların güçlü bir belirleyicisidir. Koroner akım rezervi (KAR) mikrovasküler fonksiyonun göstergesidir ve MetS'de bozulduğu gösterilmiştir. Arteriyel elastikiyetin değerlendirilmesinde aortik sertlik (AS) basit ve önemli bir metottur. Bu çalışmada MetS'li hastalarda bozulmuş koroner akım ve aortik elastisite arasında bağımsız bir ilişki olup olmadığının değerlendirilmesi amaçlanmıştır. YÖNTEMLER: Enine kesitli gözlemsel çalışmaya güncellenmiş ATP III kriterlerine göre MetS tanısı alan 46 hasta (ortalama yaş 47.3±6.6 yıl) ve 44 kontrol (ortalama yaş 46.0±6.1 yıl) hastası alındı. Pik diyastolik koroner akım, distal sol ön koroner arterden adenozin infüzyonu öncesi ve sonrasında transtorasik nabız dalga Doppler ile ölçüldü ve hiperemik pik diyastolik hızın başlangıç zirve diyastolik hıza oranı KAR olarak kabul edildi. M-mode ekokardiyografi ile aortik strain, distensibilite ve sertlik hesaplandı. İstatistiksel analizde Student t-testi, Ki-kare testi, Pearson korelasyon ve lineer regresyon analizleri kullanıldı. BULGULAR: MetS'li hastalarda kontrol grubuna kıyasla KAR'ı düşük (2.3±0.2'ye karşılık 2.7±0.2, p0.001), aortik distensibilite düşük (10.4±3.5'e karşılık 12.7±3.4, p=0.002) ve sertlik ise anlamlı yüksek saptandı (6.5±2.0'e karşılık 3.2±0.8, p0.001). Lineer regresyon analizinde, AS (β=-0.217, p=0.047), sistolik kan basıncı (β=-0.215, p=0.050) ve bel çevresi (β=-0.272, p=0.012) ile KAR'daki bozulma arasında bağımsız bir ilişki olduğu saptandı. SONUÇ: MetS'li hastalarda koroner akım rezervi bozulmuştur ve artmış aort sertliği, bel çevresi ve sistolik kan basıncı ile azalmış koroner akım rezervi arasında bağımsız bir ilişki vardır.

Kounis syndrome refers to the concurrence of acute coronary events and allergic or hypersensitivity reactions. In this report, we describe the case of a male patient, in whom acute ST-segment elevation and myocardial infarction developed immediately after injection of depot penicillin, and we discuss the Kounis syndrome. A 52-year-old male patient had chest pain, hypotension and ST-elevation on leads DI and aVL of electrocardiography 30 minutes after intramuscular penicillin injection due to cryptic tonsillitis. Kounis syndrome was considered as a possible diagnosis according to the presentation. Histamine and tryptase levels were not studied due to the delay on arrival to the emergency department. The patient promptly underwent coronary angiography, which revealed only diffuse plaques in all main coronary arteries without any obstructive lesion. We found only increased immunoglobulin (Ig) E, which is associated with the syndrome. With this report, we remind clinicians to consider Kounis syndrome in patients who are subjected to allergenic substances and demonstrate acute chest pain.

OBJECTIVES Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Epicardial fat thickness (EFT) reflects visceral adiposity and is considered an important cardiometabolic marker. In this study, we aimed to examine the presence of an association between CFR and EFT in MetS patients. METHODS Forty-six MetS patients (25 men, mean age 47.3±6.6 years) and 44 age-matched and sex-matched controls (24 men, mean age 46.0±6.1 years) were prospectively studied. Both CFR and EFT were measured by transthoracic echocardiography. Peak diastolic coronary flow velocities were measured in the left anterior descending artery by pulsed wave Doppler at the baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. RESULTS The waist circumference, total and low-density lipoprotein-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressures, and high sensitive C-reactive protein were significantly higher in MetS patients. The mean EFT was significantly higher in MetS patients compared with the controls (8.7±0.2 vs. 4.8±0.1 mm, P

Aim: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder which is reported as the hepatic manifestation of metabolic syndrome with an increased risk of cardiovascular events. Patients with NAFLD are also at risk of future cardiac events independently of metabolic syndrome. The aim of this study was to examine serum concentrations of heart type fatty acid binding protein (H-FABP) in NAFLD and to investigate its correlations with metabolic parameters and subclinical atherosclerosis. Patients and methods: A total of 34 patients with NAFLD and 35 healthy subjects were enrolled in the study. NAFLD patients had elevated liver enzymes and steatosis graded on ultrasonography. Healthy subjects had normal liver enzymes and no steatosis on ultrasonography. H-FABP levels were measured using an enzyme linked immunosorbent assay (ELISA) method and correlations with metabolic parameters and subclinical atherosclerosis were examined. Subclinical atherosclerosis was determined with carotid artery intima-media thickness (CIMT) which was measured by high resolution B mode ultrasonography. Results: H-FABP levels were elevated in patients with NAFLD (16.3 ± 4.0 ng/ml) when compared with healthy controls (13.8 ± 2.1 ng/ml; p < 0.001). NAFLD patients had significantly higher CIMT than the controls had (0.64 ± 0.17 mm vs. 0.43 ± 0.14 mm, p = 0.009). The H-FABP concentrations were significantly positively correlated with body mass index (r = 0.255, p = 0.042), fasting blood glucose level (r = 0.300, p = 0.013), CIMT (r = 0.335, p = 0.043), and homeostasis model assessment-estimated insulin resistance (HOMA-IR; r = 0.156, p = 0.306). In multiple linear regression analysis, H-FABP levels were only independently associated with CIMT (p = 0.04) Conclusion: Serum H-FABP concentrations increase in patients with NAFLD. Our results may not only suggest that H-FABP is a marker of subclinical myocardial damage in patients with NAFLD but also of subclinical atherosclerosis, independent of metabolic syndrome and cardiac risk factors. © 2013 Urban & Vogel.

Studies carried out on sheep's have suggested possible effects of hematological parameters on coronary flow reserve (CFR). However, there is no study published investigating possible effects of hematological parameters and blood viscosity on coronary haemorheology and CFR in humans. We investigated the possible effects of hematological parameters on CFR using transthoracic echocardiography.This study was conducted on 142 healthy subjects free of known cardiovascular risk factors between ages of 18-50 years. Hematological parameters were measured using an automated blood analyzer. Transthoracic echocardiographic examination including CFR measurement was performed on each subject using an Acuson Sequoia C256 Echocardiography System.The study group (142 subject) was divided into two according to the mean CFR values as the group with lower than mean CFR value and the group with upper than mean CFR value. Hematocrit (42.21+/-3.86 vs 40.27+/-3.97, P=0.004), LDL cholesterol, hsCRP values differed between the lower CFR and higher CFR groups. The other hematological parameters including hemoglobin value were similar between the two groups. hsCRP (beta=-0.334, P=0.001), mitral E/A ratio (beta=0.119, P=0.024), and haematocrit (beta=-0.161, P=0.064) values were the independent predictors of CFR. In women's subgroup, age, hemoglobin, hematocrit, and hsCRP values tended to differ between the lower CFR and the higher CFR subgroups. In men's subgroup systolic blood pressure, hsCRP, and mitral E velocity were different between the two groups.In addition to the coronary endothelial and coronary microvascular functions, hematocrit and blood viscosity might have some effect on coronary haemorheology and CFR.

BACKGROUND In this study, we searched for a correlation between transthoracic coronary flow reserve (CFR) and well-established surrogates of coronary atherosclerosis. METHODS The study was conducted on 136 healthy subjects (mean age: 39.9 +/- 7.3 years) who were free of coronary risk factors. Transthoracic echocardiography was used to measure the aortic stiffness index (AoSI), aortic distensibility (AoD), and aortic elastic modulus (AoEM). High-resolution ultrasound was used to measure brachial artery endothelium-dependent and independent vasomotion and carotid intima-media thickness (IMT). In addition, transthoracic second harmonic Doppler echocardiography was used to measure CFR. RESULTS All of the parameters significantly correlated with each other except brachial endothelium-independent dilation. CFR correlated significantly with brachial endothelium-dependent dilation (EDD) (r = 0.302, P < 0.01), carotid IMT (r =-0.388, P < 0.01), brachial artery diameter (r = 0.340, P < 0.01), AoD (r = 0.275, P < 0.01), AoS (r =-0.299, P < 0.01), and AoEM (r =-0.30,7 P < 0.01). Carotid IMT correlated significantly with brachial EDD and modestly with brachial artery diameter, AoD, AoS, and AoEM.In multivariate analysis, carotid IMT (beta=-0.323, P < 0.0001) and brachial artery diameter (beta = -0.259, P = 0.001) were significant independent predictors of CFR. The left ventricular mass index (beta= 0.371, P < 0.0001), brachial EDD (beta = -0.232, P = 0.002), and CFR (beta = -0.228, P = 0.003) were significant predictors for IMT. CONCLUSION Transthoracic CFR correlated significantly with well-established noninvasive predictors of atherosclerosis, and we suggest that it can be used as a surrogate for coronary atherosclerosis.

Atenolol and nebivolol are commonly used antihypertensive agents. Nebivolol increases both stimulated and basal release of endothelial nitric oxide, thereby improving flow-mediated dilatation of the brachial artery in patients with essential hypertension.1 However, it is believed that atenolol has no effect on arterial vasoreactivity.1 Pharmacological stress transthoracic second harmonic Doppler echocardiography (TTDE) is a useful tool in evaluating coronary flow reserve (CFR). Several studies have evaluated its feasibility.2 We hypothesised that in patients with essential hypertension, nebivolol can reverse coronary microvascular dysfunction and improve CFR. After one month of lifestyle changes, 63 consecutive patients with hypertension had 24 h ambulatory blood pressure monitoring. Hypertension was diagnosed in 30 of these who had average daytime blood pressure > 135/85 mm Hg and average night-time blood pressure > 125/75 mm Hg. These 30 patients constituted the study population. For the control group, 30 healthy volunteers were enrolled. Patients with known cardiovascular risk factors, those who were taking any vasoactive or hypertension drug, and those with ECG changes specific for myocardial ischaemia were excluded from the study. Written informed consent was obtained from each participant, and the institutional ethics committee approved the …