Search

The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient or inpatient settings and was developed to predict the survival of heart failure (HF) patients after hospitalization.This study aims to determine the prognostic significance of MAGGIC risk score combined with electrocardiography (ECG) parameters in decompensated patients with heart failure with reduced left ventricular ejection fraction (HFrEF) who were hospitalized for worsening HF.A total of 562 HF patients with New York Heart Association (NYHA) II-IV functional class who were discharged after hospitalization for decompensated HF between 2013 and 2018 in a single center were included. MAGGIC risk scores of all participating patients were calculated according to baseline characteristics gathered using data from the initial hospitalization for HF. In addition, electrocardiographic findings of all patients were examined.During the follow-up period (4.5 ± 1.2 years) 177 patients died. MAGGIC scores were observed to be higher in non-survivors compared to surviving patients (28.69 ± 7.01 vs. 22.82 ± 6.05, p0.001). After a multivariate analysis, MAGGIC score (OR:1.090, p0.001), development of cardio-renal syndrome (OR:2.035, p0.001), presence of left bundle branch block (LBBB) (OR:1.931, p0.001), atrial fibrillation (AF) (OR:1.817, p0.001), and fragmented QRS (fQRS) (OR:1.671, p = 0.002) on ECG were found to be independent predictors of mortality. While the MAGGIC score was shown to predict mortality (AUC = 0.739), its predictive power was improved when combined with AF (AUC = 0.752), LBBB (AUC = 0.745), and fQRS (AUC = 0.757) respectively, as well as in the combined final model (MAGGIC score, AF, LBBB, fQRS) (AUC = 0.787).Our findings showed that addition of electrocardiographic findings to the MAGGIC heart failure risk score has prognostic significance in decompensated patients with HFrEF.

Objective: The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coro nary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. Methods: A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. Results: The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an inde pendent predictor of in-hospital mortality. Conclusion: In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important. © 2021 Turkish Society of Cardiology. All rights reserved.

Objectives: The prognostic significance of SYNTAX Score II (SS-II) is well-known in patients with chronic coronary syndromes. However, its predictive ability for mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI) remains unclear. Therefore, we aimed to investigate the prognostic accuracy of SS-II in STEMI patients who underwent p-PCI. Methods: A total of 743 STEMI patients treated with p-PCI were retrospectively analyzed. Study population was divided into three groups according to SS-II and defined as SS-IILOW ≤22.5 (n=245), 22.5 31 (n=255). Inhospital and long-term mortality at long-term follow-up were defined as clinical endpoints of the study. Results: The incidence of in-hospital (15% vs. 0.4% vs. 0.8%, p 31 group (P [log-rank] 31 was defined as an independent predictor of all-cause mortality (hazard ratio 5.22 95% confidence interval 2.11–12.87 p

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Objective COVID-19 is a disease with high mortality, and risk factors for worse clinical outcome have not been well-defined yet. The aim of this study is to delineate the prognostic importance of presence of concomitant cardiac injury on admission in patients with COVID-19. Methods For this multi-center retrospective study, data of consecutive patients who were treated for COVID-19 between March 20 - April 20 2020 were collected. Clinical characteristics, laboratory findings and outcomes data were obtained from electronic medical records. In-hospital clinical outcome was compared between patients with and without cardiac injury. Results A total of 607 hospitalized patients with COVID-19 were included in the study; the median age was 62.5±14.3 years, and 334 (55%) were male. Cardiac injury was detected in 150 (24.7%) of patients included in the study. Mortality rate was higher in patients with cardiac injury (42% vs. 8%; p Conclusion Cardiac injury on admission is associated with worse clinical outcome and higher mortality risk in COVID-19 patients including patients free of previous CAD diagnosis. Funding Acknowledgement Type of funding sources: None.

Introduction: Coronary artery ectasia (CAE) is defined as localized or diffuse dilatation of the epicardial coronary arteries. We aimed to elucidate the relationship between the CHA(2)DS(2)-VASc score and CAE. Methods: The study population consisted of 122 patients with isolated CAE and 87 sex- and age-matched control subjects. The demographic, clinical, and laboratory profiles and CHA(2)DS(2)-VASc scores of patients with CAE and the control group were compared. The Markis classification was used to determine the extent of CAE. Coronary arteries in which ectasia was localized were identified. CHA(2)DS(2)-VASc scores were calculated for all patients. Parameters predicting the development of CAE were analyzed with multivariate logistic regression. Results: The majority of patients with CAE were male (76, 62%) and their mean age was 58.4 ± 8.3. The CHA(2)DS(2)-VASc score of the CAE group was significantly higher than that of the control group (2.41 ± 1.12 vs 1.52 ± 0.73, P < 0.001). Multivariate regression analysis showed that the CHA(2)DS(2)-VASc score (odds ratio [OR] = 1.607, P = 0.004), left ventricular ejection fraction (OR = 0.953, P = 0.044), uric acid (OR = 1.569, P = 0.003), white blood cell count (OR = 1.001, P < 0.001), highly sensitive C-reactive protein level (OR = 1.115, P = 0.010), and smoking (OR = 2.019, P = 0.043) were independent predictors of CAE. Conclusion: High CHA(2)DS(2)-VASc scores were associated with isolated CAE; therefore, the score might be a useful predictor of coronary thrombus development in patients with isolated CAE.

Objective: COVID-19 spread worldwide, causing severe morbidity and mortality and this process still continues. The aim of this study to investigate the prognostic value of right ventricular (RV) strain in patients with COVID-19. Methods: Consecutive adult patients admitted to the emergency room for COVID-19 between 1 and 30 April were included in this study. ECG was performed on hospital admission and was evaluated as blind. RV strain was defined as in the presence of one or more of the following ECG findings: complete or incomplete right ventricular branch block (RBBB), negative T wave in V1-V4 and presence of S1Q3T3. The main outcome measure was death during hospitalization. The relationship of variables to the main outcome was evaluated by multivariable Cox regression analysis. Results: A total of 324 patients with COVID-19 were included in the study; majority of patients were male (187, 58%) and mean age was 64.2 +/- 14.1. Ninety-five patients (29%) had right ventricular strain according to ECG and 66 patients (20%) had died. After a multivariable survival analysis, presence of RV strain on ECG (OR: 4.385, 95% CI: 2.226-8.638, p < 0.001), high-sensitivity troponin I (hs-TnI), d-dimer and age were independent predictors of mortality. Conclusion: Presence of right ventricular strain pattern on ECG is associated with in hospital mortality in patients with COVID-19. (C) 2021 Elsevier Inc. All rights reserved.

Objective: This study is designed to evaluate the recently developed AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) risk score (RS), which determines the predisposition to thromboembolic and hemorrhagic events in atrial fibrillation, as a predictor of prognosis in patients having acute myocardial infarction (AMI), and to compare the predictive ability of ATRIA RS with GRACE RS. Methods: We analyzed 1627 patients having AMI who underwent coronary angiography and/or percutaneous coronary intervention (PCI) between January 2011 and February 2015. The primary endpoints included all-cause mortality, non-fatal MI, and cerebrovascular events during follow-up. Results: Multivariate Cox regression analysis showed that the ATRIA RS>3 was an independent predictor of major adverse cardiac events in patients with AMI [hazard ratio, 2.00, 95% confidence interval, 1.54 to 2.60, p

Background COVID-19 is a multisystemic disease that affects many organs and has metabolic effects. Aims This study aims to investigate the effect of the temporal changes of lipid levels on the prognosis during the course of the disease. Study design Retrospective cross-sectional study. Methods For this single-center study, data of patients who were treated for COVID-19 were collected. Fasting lipid parameters including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels were collected within 24 h of hospitalization. For investigation of temoral changes in lipid parameters, the results of the same parameters in the one-year period before COVID-19 were collected from medical records. A total number of 324 eligible COVID-19 patients were included in this study. The association of changes of lipid parameters with COVID-19 symptom severity and in-hospital mortality were investigated. Results The mean age of the severe group (n = 139) was 65.4 ± 15.5 years, and 60% were male. TC, LDL-C and HDL-C levels were significantly lower compared to pre-COVID measurements in the study population. Multiple linear regression analysis determined age, acute kidney injury, hs-Troponin, D-dimer, temporal changes in TC, and TG levels were determined as independent predictors for the development of COVID-19 mortality. Conclusion Our findings showed that temporal changes in lipid parameters before and after COVID-19 may be associated with mortality and in-hospital adverse outcomes.

Aim: We purposed to evaluate the correlation between the rate of increase in SCrea levels and major adverse cardiac and cerebrovascular events(MACCE) in non ST-segment elevation myocardial infarction(NSTEMI) patients who was made coronary angiography(CAG) in this study. According to studies on especially stable coronary artery disease (SCAD); contrast-induced acute kidney injury CI-AKI) is described as an rising in serum creatinine (SCrea) levels more than 0.5 mg / dl or more than 25% within 48-72 hours after the contrast agent implementation. However, data on the increase rates of SCrea levels in patients with acute coronary syndrome (ACS) are insufficient..Materials and Methods: 884 NSTEMI patients were admitted to our study. We classified the patients into 3 groups according to the increase rates in SCrea values; first group(∆SCrea 10%), second group(10%≤ ∆SCrea 25%) and third group(∆SCrea ≥25%). Results: MACCE were defined as all-cause mortality, myocardial infarction (MI) and cerebrovascular accident (CVA) at one year follow-up. MACCE occurred in 123(13.9%) of the 884 patients. Patients in group three had a meaningfully higher rate of MACCE than in the other groups (P 0.001). This difference was primarily sourced from all-causes mortality; the all-causes mortality ratio was 3-4 times higher than the other groups. There was no meaningful difference in MACCE among first and second groups.Conclusion: Using an increase rate of ≥25% creatinine as the definition for CI-AKI is more reliable for primary end points in patients with NSTEMI than the increase rate of creatine in lower levels.

Contrast-induced acute kidney injury (CI-AKI) is associated with increased mortality, morbidity, and prolonged hospitalization. Patients with acute coronary syndrome (ACS) have a 3-fold higher risk of developing CI-AKI. The aim of our study was to evaluate the predictors of CI-AKI and long-term prognosis in patients with ACS who developed CI-AKI (1083 patients were enrolled). Contrast-induced acute kidney injury was defined as an increase of ≥0.5 mg/dL and/or an increase of ≥25% of pre-percutaneous coronary intervention (PCI) to post-PCI serum creatinine levels within 48 to 72 hours after the procedure. Primary end point was defined as all-cause mortality, myocardial infarction, and cerebrovascular event at long-term follow-up (36 ± 12 months). Contrast-induced acute kidney injury occurred in 178 (16.4%) of the 1083 patients. The primary end points were significantly high in patients with ACS who developed CI-AKI ( P < .001). The occurrence of CI-AKI was identified as an independent predictor of primary end point. Risk of CI-AKI development was more frequently seen in patients with ACS. Also, patients who developed CI-AKI have worse prognosis at long-term follow-up. Additional preventive treatment strategies need to be developed in this group of patients.

The heart is one of the most affected organs during electric injuries. In electrical injuries, mechanical complications such as myocardial rupture, valvular rupture, pericardial effusion as well as a variety of arrhythmias ranging from electrocardiographic changes to ventricular fibrillation may occur. In this paper, we have presented a female patient with twin pregnancy at the 26th week of gestation, in whom syncope due to electric shock occurred and atrial fibrillation was detected on admission to the emergency department and have discussed treatment methods.

Amantadine hydrochloride is an antiviral agent that is also effective in the treatment of Parkinson's disease. In the literature, cardiac arrhythmia is reported in toxic doses of amantadine, but in this paper we report a patient with right ventricular outflow tract (RVOT) tachycardia after an initial dose of amantadine. A 47-year-old female patient was admitted to the emergency department with the complaint of palpitation and dizziness after taking 200 mg amantadine. A 12-lead standard ECG showed wide QRS complex tachycardia with a heart rate of 167/min. The wide QRS complex tachycardia had an inferior axis and left bundle branch block morphology, compatible with RVOT ventricular tachycardia (RVOT-VT). Tachycardia terminated spontaneously and sinus ECG was completely normal. No arrhythmia was inducible at the electrophysiological study. To the best of our knowledge, this is the first case in the literature to describe RVOT-VT after amantadine intake. Amantadine may cause RVOT-VT as well as other cardiac arrhythmias.

Objectives. Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Easy-to-perform and reliable parameters are needed to predict the presence and severity of CAD and to implement efficient diagnostic and therapeutic modalities. We aimed to examine whether the Framingham risk scoring system can be used for this purpose. Methods. A total of 222 patients (96 women, 126 men; mean age, 59.1±11.9 years) who underwent coronary angiography were enrolled in the study. Presence of >%50 stenosis in a coronary artery was assessed as critical CAD. The Framingham risk score (FRS) was calculated for each patient. CAD severity was assessed by the Gensini score. The relationship between the FRS and the Gensini score was analyzed by correlation and regression analyses. Results. The mean Gensini score was 18.9±25.8, the median Gensini score was 7.5 (0-172), the mean FRS was 7.7±4.2, and the median FRS was 7 (0-21). Correlation analysis revealed a significant relationship between FRS and Gensini score (r=0.432, p

BACKGROUND: Although the prevalence of coronary artery anomalies varies in different series, the precise population frequency is unknown. MATERIALS AND METHODS: The medical records of all patients who underwent coronary angiography between January 2002 and August 2012 were retrieved, and 238 cases with coronary anomalies were evaluated. Unlike other studies, we compared several angiographic parameters (fluoroscopy time, number of images, and catheters used) in addition to frequency and sex data. RESULTS: The angiographic frequency of coronary artery anomalies was 0.94%. The most common coronary anomaly was a left anterior descending-circumflex artery originating from separate ostia (0.29%). The second most common anomaly was a right coronary artery (RCA) originating from the left sinus of Valsalva (sV) (0.23%). Overall, coronary artery anomalies (1.28 vs. 0.80%; P

Kardiyak troponinler miyokart enfarktüsü tanısında yüksek duyarlık ve özgüllüğe sahiptir. Yüksek troponin seviyeleri bazen kalp dışı nedenlerle ortaya çıkar ve yanlışlıkla akut koroner sendrom tanısı konulabilir. Bu çalışmada izole troponin yüksekliği saptanmış bir olguyu sunuyoruz, Cardiac troponins have high clinical sensitivity and specificity for the detection of myocardial injury. Elevated cardiac troponin levels may also occur in non cardiovascular conditions, leading to a misdiagnosis of acute coronary syndrome. In this paper, we report a case of unexplained isolated elevation of troponin

WOS: 000318703600010, PubMed: 23263241, The aim of this study was to compare the effects of the new generation beta-blocker anti-hypertensive drugs carvedilol and nebivolol on aortic elastic properties which are important indicators of hypertension-related morbidity and mortality. A total of 50 patients who had been diagnosed with stage 1 hypertension according to the Joint National Committee (JNC) VII criteria and who had not received any anti-hypertensive treatment were enrolled in this study. Patients were randomized to receive either 25 mg/day carvedilol (n = 25) or 5 mg/day nebivolol (n = 25) for 3 months at the beginning of the study. Three patients (1 in the carvedilol group, 2 in the nebivolol group) who did not attend 3 month follow-up measurements were excluded from the study. The study was completed with 47 patients (25 women; mean age: 49 +/- 9 years). The aortic elastic parameters such as aortic strain (AS), aortic distensibility (AD), and aortic stiffness index (ASI) were measured by echocardiography. Carvedilol and nebivolol provided a similar decline in both systolic and diastolic blood pressures (-12/-7 mmHg, p < 0.0001 and -12/-7 mmHg, p = 0.002, respectively). Both carvedilol and nebivolol induced a significant decrease in heart rate (-aEuro parts per thousand 15 bpm, p < 0.0001, -aEuro parts per thousand 17 bpm, p < 0.0001, respectively). Even though the heart rate at the end of the treatment was lower for the nebivolol group, the rate of decrease of heart rates between carvedilol and nebivolol groups was not statistically significant (p = 0.074). Both groups demonstrated improvements in the diastolic functions of the left ventricle where certain values showed more improvement for the nebivolol group. Both groups showed improvements in AS and AD rates compared to basal rates; however, these improvements were not statistically significant. Although the improvement rates in AS, AD, and ASI were higher in the nebivolol group compared to the carvedilol group, the differences were not statistically significant (p = 0.091, p = 0.095, p = 0.259, respectively). Both carvedilol and nebivolol induced a decrease in blood pressure and heart rate and showed an improvement in left ventricular diastolic functions. It was observed that both drugs did not cause deterioration in the aortic elastic properties but a slight improvement was seen. However, this improvement was not statistically significant. The improvement was more explicit in the nebivolol group. It may be concluded that nebivolol is slightly superior to carvedilol in reducing heart rate and improving left ventricular diastolic functions. However, further long-term studies with larger sample sizes should be performed in order to better define the effects of both drugs.

The Clinical SYNTAX Score (CSS) combines anatomical and clinical risk assessment.This study was designed to evaluate CSS as a predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (p-PCI).We evaluated 433 patients who were diagnosed with STEMI and underwent p-PCI. CSS was calculated by multiplying the anatomically derived SYNTAX score (Sx) by the modified age, creatinine, and ejection fraction score. Patients were divided into tertiles according to the CSS: CSS(Low)≤14 (n=141), 14CSS(Mid)≤26 (n=144), and CSS(High)26 (n=148). The primary endpoints were defined as all-cause mortality, myocardial infarction, and cerebrovascular events over 15 months' follow-up.Primary endpoints were achieved in 9.2% of patients with CSS≤14, 12.5% of those with 14CSS≤26, and 28.4% of those with CSS26 (P0.001). Kaplan-Meier analysis showed that the CSS26 group had a significantly higher incidence of primary endpoints [P (log-rank)0.001]. CSS26 was identified as an independent predictor for all-cause mortality, myocardial infarction, and cerebrovascular events (hazard ratio 3.58, 95% confidence interval 1.68-7.60, P=0.001). Receiver operating characteristic analysis found areas under the curve of 0.66, 0.59, and 0.64 for CSS, Sx score, and age, creatinine, and ejection fraction score (P0.001, P=0.01, P0.001, respectively).CSS may be better than the Sx score for predicting long-term prognosis in patients with STEMI undergoing p-PCI.

WOS: 000314532700012, PubMed: 22930391, Takotsubo cardiomyopathy, also known as broken heart syndrome, is similar to acute coronary syndrome. The absence of significant stenosis on coronary angiography and spontaneous improvement of ventricular akinesia are very important features that distinguish this syndrome from acute coronary syndromes. Despite the fact that ST segment elevations are typically encountered, atypical presentation without ECG changes should be kept in mind. We herein report the case of a 61-year-old woman who presented with mid-apical left ventricular akinesia resolving within 24 h.

WOS: 000307808100009, PubMed: 22576258, Background: The pathophysiology of atherosclerosis development in patients with diabetes mellitus (DM) is similar to that in nondiabetics. However, atherosclerosis develops earlier and runs a rapid course in patients with diabetes. Aortic stiffness, strain and distensibility are the parameters used to assess an increase in arterial stiffness and can be measured by invasive and non-invasive methods. Method: Aortic elastic properties were compared among patients with normal oral glucose tolerance test but impaired fasting glucose and healthy individuals. The study group consisted of 50 subjects with impaired fasting glucose who had no known risk factors for atherosclerosis. The control group was composed of the same number of volunteers. Results: It was found that aortic strain and distensibility were reduced (8.78 +/- 4.3 vs. 10.65 +/- 2.6 p

We herein present a case of a 76-year-old male patient presented with transient ST segment elevation and left bundle branch block caused by mad-honey poisoning. © Springer-Verlag Wien 2012.

Inherited hypercoagulopathies such as protein C and S deficiency usually lead to the formation of venous thrombi in clinical practice; however, they rarely lead to arterial thrombosis. It has been demonstrated that both protein C and S deficiency may lead to myocardial infarctions. However, our literature review revealed no reports of left main coronary artery thrombi caused by protein C and S deficiency. This paper presents a case of a left main coronary artery thrombus resulting from protein C and S deficiency in a young patient with normal coronary arteries.

Background: Our aim was to investigate whether diastolic functions, myocardial velocities and pulmonary vein flow show diurnal variation within a 24-hour day. Method and Results: Fourty-four healthy subjects with no history of cardiovascular or systemic diseases (32 males, 12 females; mean age 34.7 ± 8.7 years, mean BMI: 25.5 ± 3.5 kg/m2) were enrolled in this study. None of the subjects had a history, symptoms or signs of cardiovascular or systemic diseases or were taking drugs of any kind. All underwent echocardiographic examination at 7 a.m., 1 p.m., 7 p.m., and 1 a.m. M-mode systolic, diastolic velocities and pulmonary vein flow measurements were obtained. There were no differences in systolic and diastolic blood pressures and heart rate. The left atrial diameter was greater at 1 p.m. (3.80 ± 0.44; P = 0.031). The isovolumic contraction time (ICT) was found to be the shortest (41 ± 12 msn; P = 0.050), and ejection time (ET) the longest (290 ± 31 msn; P = 0.017) at the 1am measurements. The mitral myocardial performance index (MPI) was lowest during the 1 a.m. measurements (0.42 ± 0.11; P = 0.001). The systolic myocardial velocities (Sm) obtained from the septum and inferior region were significantly higher at 1 p.m. and lower at 7 a.m. (9.17 ± 1.79, 10.25 ± 2.29; 8.11 ± 1.06, 8.63 ± 1.49; P < 0.05). The late diastolic velocities obtained from the lateral, inferior and anterior regions were higher at 1 p.m. and 7 p.m. Conclusion: The left ventricular diameter and ejection fraction did not exhibit circadian variations. However, our data indicate that some parameters reflecting diastolic function, systolic myocardial velocities and MPI, as well as left atrial diameter change at different times of the day, independent of blood pressure and heart rate. (Echocardiography 2011;28:612-618)

WOS: 000267560300001, PubMed: 19551157, Background/Aim. Coronary artery ectasia (CAE) is considered as a variant of atherosclerosis. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are among the sensitive markers of systemic inflammation. The aim of this study was to evaluate the plasma levels of the cytokines; TNF-alpha and IL-6 in CAE patients. Methods. Plasma concentrations of TNF-alpha and IL-6 were measured in 36 patients with CAE (28 males, mean age: 58.2 +/- 12 years), and results were compared with age and sex-matched controls (n = 32) without coronary artery ectasia. TNF-alpha and IL-6 concentrations in blood were assesed by enzyme-linked immunosorbent assay (ELISA). Results. Baseline characteristics of the two groups were similar. TNF-alpha and IL-6 levels were significantly higher in CAE group than controls (15.6 +/- 11.2 pg/mL versus 7.8 +/- 3.7 pg/mL, P

OBJECTIVE: Atrial fibrillation is one of the most common arrhythmias associated with not only increased morbidity after coronary artery bypass grafting but also increased healthcare costs. Many factors are associated with atrial fibrillation onset after coronary artery bypass grafting. We prospectively examined which factors could predict atrial fibrillation after coronary artery bypass grafting. METHODS: Fifty-seven consecutive patients (37 men, mean age=60.2±12 years) with sinus rhythm before coronary artery bypass grafting are included the study. Clinical, demographic, laboratory and echocardiographic characteristics are all evaluated prospectively. The maximum and minimum P-wave duration (Pmax and Pmin) were measured from the 12-lead surface electrocardiogram. The difference between the Pmax and the Pmin was calculated and defined as P-wave dispersion. Preoperative venous blood samples were taken for N-terminal proBrain natriuretic peptide level analysis. RESULTS: Ten (17%) patients had postoperative atrial fibrillation. Patients with postoperative atrial fibrillation were older (69.4±6 versus 58.2±12 years, P=0.01), had lower ejection fraction (44.1±8.9% versus 54.3±9; P=0.002), higher proBrain natriuretic peptide levels (538±136 pg/ml versus 293±359 pg/ml; P=0.03), longer Pmax (142.2±13.7 ms versus 120.8±21.2 ms; P=0.006) and longer P-wave dispersion (55.0±8.2 ms versus 41.3±14.3 ms; P=0.008) compared with the patients without atrial fibrillation. Univariate analysis showed that increased age (P=0.01), lower ejection fraction (P=0.02), enlargement of left atrium (P=0.02), increased Pmax (P=0.006) and increased P-wave dispersion (P=0.008) and increased level of preoperative proBrain natriuretic peptide (P=0.03) were associated with postoperative atrial fibrillation. Positive correlation was seen between the age and level of proBrain natriuretic peptide (r=0.322 and P=0.015). In multivariate analysis, age (P=0.05), lower ejection fraction (P=0.03), left atrial enlargement (P=0.05), longer Pmax (P=0.01) and P-wave dispersion (P=0.01) were found to be independent predictors of postoperative atrial fibrillation. CONCLUSION: Age, poor left ventricular functions, Pmax and P-wave dispersion are found to be independent predictors of atrial fibrillation after coronary artery bypass grafting. © 2007 Lippincott Williams & Wilkins, Inc.

Aim: This study was designed to assess whether ultrasonic reflectivity, evaluated by integrated backscatter analysis was associated with the severity of inflammation and diastolic dysfunction of the left (LV) and right ventricles (RV) in Behcet's disease (BD). Methods: The study consisted of 20 patients with BD and 18 healthy controls. The expression of CD11b and CD63 on the surface of granu- locytes and monocytes were measured by flow cytometry. RV and LV diastolic functions were assessed by tricuspid and mitral annular tissue Doppler recordings, respectively. Backscatter cyclic variation (CV) and maximal intensity (IB) were measured in RV lateral wall, interventricular septum, and posterior LV wall from parasternal long-axis view, apex from apical four-chamber view, anterior, infe- rior, and lateral LV walls from parasternal short axis view. Results: The mean fluorescence intensity (MFI) of CD11b on granulocytes and CD63 on monocytes in BD patients was higher than those of controls. Patients with BD had smaller mitral and tricuspid annular early diastolic wave velocities and early/late diastolic wave velocity ratios (E/A) than controls. MFI of CD11b and CD63 was in- versely correlated with tricuspid and mitral annular E/A in BD patients. CV of RV and global CV of LV were found to be diminished in BD patients than controls. CV of RV and global CV of LV showed a direct correlation with tricuspid and mitral annular E/A ratio, respectively. Conclusion: There is an association between the levels of cellular adhesion molecules, deterioration of diastolic function, and altered myocardial ultrasonic reflectivity in BD. (ECHOCARDIOGRAPHY, Volume 24, August 2007)

We reported a 42-year-old heterozygous protein C-deficient woman whose oral contraceptive drug induced thrombi in the right heart and pulmonary artery are resected successfully. In this article, we tried to determine the trigerring effect of oral contraceptive usage on thrombus formation in a patient with heterozygous protein C deficiency. Cessation of the oral contraceptive therapy without any additional anticoagulant drug prevented the recurrence of the thrombus formation.

Background: Left ventricular (LV) long-axis function evaluated by Doppler tissue echocardiography-derived strain rate (SR) imaging has been shown to be a useful index of LV systolic function; however, it has not been evaluated in patients with mitral stenosis (MS). We examined the LV long-axis function of patients with pure MS and normal global systolic function as assessed by LV ejection fraction. Method: In all, 30 patients (22 women; 45 ± 9 years) with mild to moderate MS (mitral valve area = 1.5 ± 0.3 cm2) and 28 healthy volunteers (20 women; 44 ± 10 years) were evaluated by both conventional and Doppler tissue echocardiography. Two-dimensional Doppler tissue echocardiography was performed in the apical 4-chamber view in the septal and lateral wall on the mitral annular level. Peak systolic myocardial SR and end-systolic strain data were measured for both segments. Results: Peak systolic SR (1.2 ± 0.4% vs 1.8 ± 0.39%, P < .001) and end-systolic strain (10 ± 5 vs 25 ± 6 s-1, P < .001) were both significantly lower in patients with MS than in control subjects. Conclusions: Patients with MS had significantly impaired long-axis function evaluated by Doppler tissue echocardiography-derived SR imaging despite normal global systolic function. Copyright 2006 by the American Society of Echocardiography.

Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is divided into six subgroups in the literature according to the origin and course of the short and long branches of the anomalous artery. We present two distinct cases of dual LAD which are distinguished by two branches of equal length from their counterparts in the literature. Learning objective: In our cases a novel dual LAD variant is presented with two main branches of equal length and reaches the cardiac apex. Cardiologists and cardiovascular surgeons should be aware of these variants to avoid misinterpretation of coronary angiography and intraoperative complications. © 2013 Japanese College of Cardiology.

Robotically enhanced telemanipulation for totally endoscopic coronary artery bypass does not provide adequate tactile feedback, traction, or countertraction. The exposition of coronary target sites is difficult, the visual field is limited, and the epicardial stabilization may be troublesome. A fourth robotic arm for endothoracic instrumentation has been added to the da Vinci surgical system to facilitate totally endoscopic operations. The stereoendoscope was upgraded with a wide-angle feature.The procedure was performed in five patients. Four of these patients had left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafting on the beating heart and the fifth had sequential bypass grafting (LITA to diagonal branch and LAD) on an arrested heart. The additional effector arm of the da Vinci surgical system was brought into the operative field beneath the operating table and used as a second right arm. The wide-angle view was activated by either the console or the patient side surgeon.The mean operative, port placement, and anastomotic times for a beating-heart totally endoscopic coronary artery bypass were 195 +/- 58, 25 +/- 10, and 18 +/- 5 min, respectively. All procedures were free of morbidity and mortality, with satisfactory angiographic control. The sequential arterial bypass grafting procedure was fully completed in totally endoscopic technique.The additional instrumentation arm and wide-angle visualization are useful technical improvements of the da Vinci surgical system, solving the problem of traction, countertraction, and facilitated exposition of target sites as well as visualization of the surgical field. They provide potential for wider acceptance of totally endoscopic coronary artery bypass grafting in a larger surgical community.

OBJECTIVE Postoperative cardiac depression is attributed to ischemia and the effects of cardiopulmonary bypass (CPB). To evaluate the effect of CPB alone on postoperative left ventricular (LV) dysfunction, we used a conductance catheter to determine the LV performance by pressure-volume relation before and after CPB. METHODS Twenty-two 3-week-old piglets underwent sternotomy and normothermic CPB for one hour. A conductance catheter was placed in the LV cavity. End-systolic pressure-volume relationships (ESPVR), left ventricular end-diastolic pressure (LVEDP) and systemic vascular resistance (SVR) were measured under steady-state conditions before and 15 min after weaning from CPB in group A (n = 11). Group B included 11 piglets without CPB and served as control. RESULTS There was no difference between groups before initiating CPB. As an indication of depressed LV function, the ESPVR slope (mmHg/ml) was significantly lower in group A after weaning from CPB than in group B (1.69 +/- 0.5 vs. 1.86 +/- 0.55; p = 0.008). In group A, peak dP/dt (max index) (mmHg/s/m (2)) decreased markedly (1596 +/- 339 vs. 2045 +/- 206; p = 0.03), while LVEDP (mmHg) was significantly increased (11.7 +/- 2.6 vs. 5.4 +/- 0.9; p < 0.0001). In addition, SVR (index) (dyn x s x cm (-5)/m (2)) in group A was significantly lower (1407 +/- 176 vs. 1677 +/- 313; p < 0.0001) than in group B. CONCLUSION Using the very sensitive conductance catheter technique in a pig model, we could show that CPB leads to a significant depression of LV contractility and elastance even without ischemic arrest.

Background: Off-pump coronary artery bypass grafting was implemented to reduce trauma of surgical coronary revascularization by avoiding extracorporeal circulation. High thoracic epidural anesthesia further reduces intraoperative stress and postoperative pain. In addition, this technique even allows awake coronary artery bypass grafting, avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients. Methods Thirty-four patients underwent awake coronary artery bypass grafting with left internal thoracic artery to left anterior descending coronary artery by partial lower ministernotomy (n = 20), H-graft technique (n = 2), or rib cage–lifting technique (n = 2). In 9 cases we performed double bypass grafting, and in 1 case we performed triple-vessel coronary artery revascularization through complete median sternotomy. In addition to clinical outcomes, visual analog scale pain scores were recorded on days 1, 2, and 3 after surgery. Results Thirty-one patients remained awake throughout the whole procedure. Three patients required secondary intubation because of incomplete analgesia (n = 1) or pneumothorax (n = 2). Procedure time was 90 ± 31 minutes, and recovery room stay was 4.2 ± 0.6 hours. There were no in-hospital deaths or serious postoperative complications. In 1 case a graft occlusion was documented on predischarge angiography. Early postoperative pain was low (visual analog scale score of 30 ± 6). Conclusion These data demonstrate the feasibility and safety of various surgical coronary revascularization techniques without general anesthesia. Continuation of thoracic epidural analgesia provides good pain control and fast mobilization postoperatively. Surprisingly, the awake coronary artery bypass grafting procedure was well accepted by the patients.

A foreign body such as a needle in the heart can be life-threatening. While this may occur accidentally, needles may be inserted into the body by psychiatric patients or in cases involving domestic violence. A needle can migrate through the thorax toward the heart. In drug users, needles may also reach the right ventricle via the peripheral veins. Cardiac injury can occur via the esophagus after swallowing a needle. The clinical outcome may vary from an asymptomatic situation to tamponade or shock, depending on how severely the cardiac structures are affected. In injuries involving the thorax, pneumothorax may cause sudden shortness of breath. Here, we report the case of a 34-year-old male prison inmate who accidentally lodged a pin in his left ventricle while asleep. As he has refused surgery, it was decided to follow the patient carefully.

BACKGROUND Since its introduction in the field of cardiac surgery in 1997, computer-enhanced telemanipulation has been used in a number of different specialized areas. In cardiac surgery, various procedures have been successfully completed in totally endoscopic fashion ever since. Between June 1999 and January 2002, 75 closed-chest cardiac procedures have been performed at our institution using the da Vinci telemanipulation system. PATIENTS AND METHODS In 42 patients, a single-vessel totally endoscopic coronary artery bypass was performed on the arrested heart (left internal thoracic artery (LITA) to left anterior descending artery (LAD), n = 36; right internal thoracic artery (RITA) to right coronary artery (RCA), n = 6). 12 patients had different types of multivessel revascularization using both internal thoracic arteries. 8 patients underwent LITA-to-LAD grafting on the beating heart. 10 patients underwent closure of an atrial septal defect (9 direct, 1 patch). 3 patients received an epicardial left ventricular pacemaker lead, 2 of which were reoperations. RESULTS Overall conversion rate to any kind of incision was 25 %. The last 26 LITA to LAD patients on the arrested heart had a conversion rate of 4 %. There were no mortalities, 3 patients required reexploration via a median sternotomy, and one patient suffered a hypoxemic brain damage. The first 22 TECAB patients demonstrated excellent graft patency in angiographic control upon discharge. None of the atrial septal defect (ASD) closures showed any residual shunt on the intraoperative transesophageal echocardiogram (TEE). Patients with end-stage heart failure had successful biventricular stimulation. CONCLUSION Our current experience confirms the feasibility of various totally endoscopic cardiac procedures with good clinical outcomes. After a steep learning curve, the conversion rate could be lowered to an acceptable figure. Some of these procedures at our institution became a reasonable treatment alternative in selected patients.

Telemanipulators have been introduced into cardiac surgery recently expanding the scope of minimally invasive techniques and enabling endoscopic cardiac surgery. Our aim was to evaluate clinical results of totally endoscopic single vessel bypass grafting on the arrested as well as on the beating heart. Since 1999, 44 totally endoscopic single vessel arterial bypass grafting procedures were performed at our institution. Thirty-eight procedures were performed on the arrested heart (group A), and six such procedures on the beating heart (group B) using the daVinci telemanipulation system. In group A, totally endoscopic coronary artery bypass grafting (TECAB) with left internal thoracic artery (LITA) to left anterior descending artery (LAD) was performed in 33 patients and right internal thoracic artery (RITA) to right coronary artery (RCA) grafting in five cases. The overall conversion rate in group A was 18.4% and dropped down to 5% in the last 20 cases. In group B( n ¼ 6), four patients received successful LITA to LAD grafting; two patients (33%) required conversion to minithoracotomy. The first 22 TECAB patients of group A (58%) had control angiography and demonstrated excellent graft patency upon discharge. All grafts in group B showed excellent function on angiographic control as well. The mean procedural time for single vessel TECAB was 4.2 ^ 0.9 h, cardiopulmonary bypass (CPB) time was 136 ^ 32 min and aortic cross-clamp time amounted to 61 ^ 16 min. The present data show feasibility of totally endoscopic single arterial grafting on the arrested heart in a reproducible manner, though procedural times were still prolonged due to the difficult handling of the port access system and the complex time consuming endoscopic operation. A low conversion rate was achieved in arrested heart TECAB after a relatively short learning curve and is mandatory for successful totally endoscopic off-pump bypass grafting. q 2002 Elsevier Science B.V. All rights reserved.

Fragestellung. Die hohe thorakale Periduralanasthesie (TEA) in Kombination mit einer Allgemeinanasthesie wird bereits vielfach im Rahmen der koronaren Bypasschirurgie mit und ohne extrakorporaler Zirkulation angewendet. Erste Fallberichte uber den alleinigen Einsatz einer TEA zur koronaren Eingefasrevaskularisation uber eine laterale Thorakotomie am wachen Patienten existieren. Da die myokardiale Mehrfachrevaskularisation ublicherweise jedoch nur uber eine mediane Sternotomie durchgefuhrt werden kann, berichten wir erstmals uber die Anwendung der alleinigen TEA an wachen Patienten mit koronarer Mehrgefaserkrankung, die uber eine mediane Sternotomie revaskularisiert wurden.

Hintergrund Im Zuge der Entwicklung minimalinvasiver Operationstechniken in der Herzchirurgie gehoren Koronarbypassoperationen am schlagenden Herzen und Operationen uber limitierte Zugange („Schlussellochoperationen”) inzwischen in vielen Zentren zur Routine. Eine weitere Moglichkeit der Minimierung des Operationstraumas besteht darin Patienten ohne Vollnarkose in Regionalanasthesie zu operieren. Methode Seit Marz 2001 wurde bei insgesamt 14 Patienten eine koronare Bypassoperation am schlagenden Herzen ohne Vollnarkose bei Spontanatmung durchgefuhrt. Hierzu wurde ein Periduralkatheter in Hohe von Th2–Th3 praoperativ eingelegt. Die Revaskularisation erfolgte total arteriell, wobei 8einfach, 5 zweifach und 1 dreifach Bypassgraft angelegt wurden. Die Zugange verteilten sich auf sowohl komplette als auch partielle Sternotomien. Ergebnisse Zwolf Patienten blieben wahrend der gesamten Operation wach. Zwei Patienten benotigten aufgrund einer unvollstandigen Analgesie bzw. eines Pneumothorax eine sekundare Intubation. Die mittlere Operationszeit betrug 94±18 Minuten. Der mittlere Aufenthalt auf der Uberwachungsstation betrug 4,8±0,6 Stunden. Es traten keine postoperativen Komplikationen auf. Postoperativ zeigten alle Bypasses angiographisch eine gute Funktion. Schlussfolgerung Unsere bisherigen Erfahrungen zeigen, dass eine vollstandige und sichere Revaskularisation auch am wachen Patienten moglich ist. Die Methode ermoglicht kurzere Operationszeiten, und beschleunigt die postoperative Rekonvaleszenz.

We describe a 56-year old male patient who presented with congestive heart failure and had undergone echocardiography that showed a mobile, giant left atrial mass which caused obstruction in the left ventricular outflow tract. The patient underwent a coronary angiography before operation that showed severe stenosis in the left anterior descending and circumflex artery. The patient underwent resection of the mass and coronary artery bypass grafting. The pathology of the mass was myxoma and patient had a satisfactory outcome. Cardiol Res. 2011;2(5):246-248 doi: https://doi.org/10.4021/cr84w

Objective: In this study, we examined the role of isovolumic acceleration (IVA) measured with right ventricle (RV) tissue Doppler imaging (TDI) to predict the presence of acute pulmonary embolism (APE) in hemodynamically stable patients with clinical suspicion of APE. Materials and Method: This study included 25 hemodynamically stable (systolic blood pressure >90 mmHg) patients diagnosed with APE for the first time. Twenty-five subjects with similar demographic characteristics in whom APE was excluded due to preexisting clinical suspicion were also enrolled as the control group. All control group subjects were enrolled after proved to have no evidence of APE on imaging. Both groups were compared with respect to RV-IVA measured with TDI in addition to conventional echocardiographic parameters. Results: Among the echocardiography parameters, only RV-IVA was impaired in patients with hemodynamically stable APE compared to controls (2.85 [1.37-6.42] m/sec2 vs. 3.32 [2.24-6.52] m/sec2, respectively; P = 0.02). A receiver operating characteristic (ROC) analysis was performed to determine the RV-IVA value to predict clinically suspected APE. A cutoff level of 3.22 m/sec2 had a sensitivity of 64% and a specificity of 60%; a cutoff level of 3.17 m/sec2 had a sensitivity of 64% and a specificity of 64%; and a cutoff level of 3.10 m/sec2 had a sensitivity of 60% and specificity of 64% (ROC area under curve: 0.691, 95% CI: 0.543-0.839, P = 0.02). Conclusion: Results of our study suggest that RV-IVA may be a useful parameter to detect subtle alterations in RV and may predict the presence of APE in hemodynamically stable patients. © 2014, Wiley Periodicals, Inc.

Das Port-AccessTM-System stellt ein neues Verfahren zum minimal invasiven Anschluss der extrakorporalen Zirkulation dar und ermoglicht koronare Mehrfachrevaskularisation uber limitierte Zugange. In der vorliegenden Kohortenstudie wurden die klinischen Ergebnisse der femoralen (Gruppe A, n=32) mit der aortalen Kanulierung der Port-AccessTM Technik (Gruppe B, n=12) bei aortokoronarer Bypassrevaskularisation in einem ausgewahlten Patientenkollektiv verglichen. Die durchschnittliche Operationszeit betrug in Gruppe A 272±85min vs. 244±92min in Gruppe B, die Bypass-Zeit war 128±49 vs. 107±41min und die Ischamie-Zeit betrug 53±16 vs. 46±11min (p

Der Einsatz neuer Technologien der extrakorporalen Zirkulation, neuem Spezialinstrumentarium, sowie die Verwendung von intrathorakalen Visualisierungssystemen ermoglicht die Durchfuhrung von Operationen an der Mitralklappe uber eine limitierte rechts-anterolaterale Thorakotomie.

Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe an unusual approach for permanent pacemaker implantation using the azygous vein in a patient with occlusion of the bilateral total subclavian and innominate veins after previous bilateral pectoral pacemaker implantation. Endocardial pacing using the azygous vein with minimal invasive thoracotomy may be a good option for patients with inaccessible subclavian route.

We present the case of a patient in anomalous origin of the left anterior descending coronary artery that caused myocardial ischemia and led to positive myocardial scintigraphic results. Coronary angiography showed that the left anterior descending coronary artery arose from the right coronary ostium-an anomaly that has been associated with chest discomfort-without atherosclerotic lesions. Left circumflex artery and the diagonal branches were arising from the left main coronary artery and the whole coronary tree were free of atherosclerosis. © 2006 Elsevier Ireland Ltd. All rights reserved.

This paper reports a 74 year-old-man with a hypertrophic cardiomyopathy associated with mid-ventricular obstruction and a secundum type atrial septal defect. He had been suffering from shortness of breath and occasional attacks of dizziness. Doppler echocardiography revealed the gradient in the mid-left ventricular area. A transesophageal echocardiogram confirmed the findings of transthoracic study and an ostium secundum-type atrial septal defect was documented. The present case represents a rare combination of hypertrophic cardiomyopathy associated with midventricular obstruction, and an ostium secundum type atrial septal defect in an elderly man. Key words: Hypertrophic cardiomyopathy, midventricular obstruction, atrial septal defect.

WOS: 000341095500012, PubMed: 23749197