Cardiology

During the past 10 years it has been shown that some patients with antibodies to phospholipids develop recurrent venous and arterial thromboses, repeated fetal loss, and thrombocytopenia. The aim of this study is to determine the importance of levels of serum anticardiolipin antibodies (ACA) in patients with coronary heart disease (CHD). The study population consisted of76 CHD patients (Group 1) and 22 healthy subjects (Group 2). Group 1 comprised three subgroups: (la) 32 patients with acute myocardial infarction (MI), (lb) 22 patients with chronic CHD and a history of MI, and ( Ic) 22 patients with CHD but without previous MI. Immunoglobulin G anticardiolipin antibodies (IgG ACA) and immunoglobulin M anticardiolipin antibodies (IgM ACA) were detected by ELISA. High IgG ACA levels were found in 36 patients (47%) in Group I , but no high levels were found in the control group. IgM ACA levels showed no significant difference between the two groups. The ACA (IgG and I@) levels showed no correlation with age, gender, risk factor profiles, platelet counts, coronary artery lesions. left ventricular function, and morbidity and mortality rates during the follow-up period of 22 months. As a result, measuremen[ of ACA in CHD patients is unlikely to yield information that is diagnostically or prognostically important. The importance of serum anticardiolipin antibody levels in the natural history and prognosis of CHD is still undetermined and remains to be clarified.

During the past 10 years it has been shown that some patients with antibodies to phospholipids develop recurrent venous and arterial thromboses, repeated fetal loss, and thrombocytopenia. The aim of this study is to determine the importance of levels of serum anticardiolipin antibodies (ACA) in patients with coronary heart disease (CHD). The study population consisted of 76 CHD patients (Group 1) and 22 healthy subjects (Group 2). Group 1 comprised three subgroups: (1a) 32 patients with acute myocardial infarction (MI), (1b) 22 patients with chronic CHD and a history of MI, and (1c) 22 patients with CHD but without previous MI. Immunoglobulin G anticardiolipin antibodies (IgG ACA) and immunoglobulin M anticardiolipin antibodies (IgM ACA) were detected by ELISA. High IgG ACA levels were found in 36 patients (47%) in Group 1, but no high levels were found in the control group. IgM ACA levels showed no significant difference between the two groups. The ACA (IgG and IgM) levels showed n...

The aim of this study was to evaluate the effects of a fixed, low-dose combination of sustained release (SR) verapamil and trandolapril in patients (pts) with mild to severe essential hypertension uncontrolled by monotherapy. The study material consisted of 138 (77 women, 61 men; mean age 51.6±10.3 years, ranged 21-70) pts. After a placebo wash-out period of one week, all

Two families with Emery-Dreifuss muscular dystrophy (EMD) are described. Several unusual features for EMD are emphasized. One of the patients had severe neuromuscular disability with inability to walk during early childhood. This patient also had mild bifacial paresis. His brothers had the typical slow progression of EMD. In some of the patients, muscle weakness distribution was more widespread than has usually been reported, with prominent involvement of finger extensors. It is suggested that there is a wide phenotypic spectrum in EMD. In both families, the disease segregated with markers spanning the EMD locus in Xq28.

We studied the effect of trandolapril 2 mg once-daily on mild-tomoderate essential hypertension in 325 overweight patients in an openlabel, prospective, multicenter study. The male patients had a body mass index >25.5 kg/m', and the females >24 kg/m'. Mild-to-moderate hypertension was defined as a baseline diastolic blood pressure (DBP) of 90 to 110 mm Hg. After a washout period of 2 weeks, patients were treated for 4 weeks. Efficacy analysis was performed on 295 patients. Mean systolic blood pressure @BP) and DBP fell significantly from 155.7 + 16.7/95.8 + 8.8 mm Hg to 136.3 f 15.9182.9 + 8.0 mm Hg at the end of treatment. The mean reductions in SBP and DBP were 20 mm Hg and 13 mm Hg, respectively. The target blood pressure (DBP <90 mm Hg and a reduction of at least 5 mm Hg) was achieved in 254 (86%) of 295 patients. There was a slight, statistically significant reduction in heart rate after drug therapy. Serum total cholesterol concentrations fell significantly from 216.5 + 40.5 mg/dL to 213.7 + 40.2 mg/dL, and low-density-lipoprotein cholesterol from 141.7 + 39.9 mg/dL to 138.3 + 39.4 mg/dL at the end of the trial. No other clinically important changes in hematologic or biochemical variables of clinical importance occurred. The overall incidence of adverse events was 9.6% and included headache in 9 patients, cough in 7, and dizziness in 6. Four patients (1.3%) withdrew from the study because of side effects, but the effects were transient and did not require treatment. We conclude that trandolapril is effective and safe for overweight patients with mild-to-moderate essential hypertension.

Background: According to recent guidelines, patients with coronary artery disease (CAD) should undergo revascularization if significant myocardial ischemia is present. Both, cardiovascular magnetic resonance (CMR) and fractional flow reserve (FFR) allow for a reliable ischemia assessment and in combination with anatomical information provided by invasive coronary angiography (CXA), such a work-up sets the basis for a decision to revascularize or not. The cost-effectiveness ratio of these two strategies is compared. Methods: Strategy 1) CMR to assess ischemia followed by CXA in ischemia-positive patients (CMR + CXA), Strategy 2) CXA followed by FFR in angiographically positive stenoses (CXA + FFR). The costs, evaluated from the third party payer perspective in Switzerland, Germany, the United Kingdom (UK), and the United States (US), included public prices of the different outpatient procedures and costs induced by procedural complications and by diagnostic errors. The effectiveness criterion was the correct identification of hemodynamically significant coronary lesion(s) (= significant CAD) complemented by full anatomical information. Test performances were derived from the published literature. Cost-effectiveness ratios for both strategies were compared for hypothetical cohorts with different pretest likelihood of significant CAD. Results: CMR + CXA and CXA + FFR were equally cost-effective at a pretest likelihood of CAD of 62% in Switzerland, 65% in Germany, 83% in the UK, and 82% in the US with costs of CHF 5′794, € 1′517, £ 2′680, and $ 2′179 per patient correctly diagnosed. Below these thresholds, CMR + CXA showed lower costs per patient correctly diagnosed than CXA + FFR. Conclusions: The CMR + CXA strategy is more cost-effective than CXA + FFR below a CAD prevalence of 62%, 65%, 83%, and 82% for the Swiss, the German, the UK, and the US health care systems, respectively. These findings may help to optimize resource utilization in the diagnosis of CAD.

Background: Left ventricular (LV) hypertrophy is the predominant phenotypic feature of hypertrophic cardiomyopathy (HCM). The significance and diverse morphology of papillary muscles (PMs) in this population is still largely undefined. Methods: We retrospectively analyzed 75 patients (pts) (50 HCM and 25 normal) who performed cardiac magnetic resonance on a 3T scanner in our institution, between 2008 and 2012. Individual PMs were manually segmented on each end-diastolic frame on short axis images in every slice in which muscle was visualized. Additionally PMs area was calculated in a mid short-axis cine image. All statistics analyses were performed using SPSS 20.0 version. Results: HCM pts and normal subjects did not differ with respect to sex distribution (66% vs 60% male), mean age (47 + 18 vs 42 + 16 years) and body surface area (1.80 + 0.17 vs 1.80 + 0.20 g/m2). All HCM pts had preserved left ventricular ejection fraction (LVEF). In the HCM population we found significantly increased LV wall mass (LVWM) (107 + 45 vs 62 + 10g/m2; p , 0.0001) with higher telediastolic volumes (80 + 15 vs 70 + 6ml/m2; p ¼ 0.04) and LVEF (70 + 6 vs 64+ 6%; p , 0.0001). Telesystolic volumes did not differ from normal subjects. In addition, maximal LV wall thickness (LVWT) was also greater is HCM pts (20 + 6 vs 10+ 2mm; p , 0.0001). The number of LV PMs in HCM group was 2.1 + 0.3 (vs 2 in all normal subjects; p ¼ 0.34). The mean PMs mass was 6 + 2g/m2 and was increased twofold compared with the normal population (3 + 1g/m2; p , 0.0001), with no gender difference. Of the 50 HCM pts, 22 (44%) had markedly increased PMs mass ≥5g/m2 (≥2 SD than the mean for controls) including three with mass ≥11g/m2. PMs area showed the same variation as PMs mass with statistically significance (4 + 2 vs 3 + 1mm2; p , 0.0001). The ratio of PMs mass to LVWM was 5 + 2% in the HCM population. We found a significant correlation between PMs mass and PMs area, and LVWM and maximal LVWT in HCM pts, but not in normal subjects. In addition, a PMs mass .3.4g/m2 (sensitivity 86%, specificity 84%; AUC ¼ 0.94, p,0.01) or PMs area .2.7mm2 (sensitivity 80%, specificity 68%; AUC ¼ 0.85, p , 0.01) were good predictors of HCM. Conclusions: In our population, both PMs mass and PMs area were predictors of the hypertrophic response. These data reinforce the importance of routinely evaluating PMs in all cases of suspected or diagnosed HCM.

Objective: Standard echocardiographic methods reflect chamber dynamics and do not provide a direct measure of myocardial fiber shortening. Therefore we evaluated longitudinal left ventricular myocardial function by tissue Doppler echocardiography; strain (S), strain rate (SR), tissue Doppler velocity (TDV) in newly diagnosed mild to moderate hypertensive patients. Methods: Our cross-sectional and observational study population consisted of 57 patients and 48 normotensive control subjects. Patients with obesity, diabetes mellitus, regional wall motion abnormality, secondary hypertension and a history or clinical evidence of cardiovascular disease, arrhythmias or conduction abnormalities were excluded from the study. Ejection fraction, endocardial fractional shortening (e FS), meridional end-systolic stress (m ESS), stress-adjusted e FS (observed /predicted e FS) were measured by M-mode echocardiography. Relationship between the left ventricular mass index and mESS was assessed by Pearson's linear regression model. Results: Hypertensive patients had significantly decreased longitudinal myocardial function compared to control subjects determined by septal (-1.25±0.30 vs.-1.02±0.33, p<0.001) and lateral (-1.20±0.28 vs. 1.02±0.41, p<0.01) SR (1/s) measurements. However, there was no significant correlation between the m ESS and strain-strain rate measurements in both normal and hypertensive subjects. Conclusions: Early impairment in longitudinal left ventricular systolic function can be expected despite normal endocardial left ventricular function indicated by M-mode echocardiography in patients with newly diagnosed and never treated mild to moderate hypertension.

names and principal investigators of the participating centres are listed at the end of the report. Objective-A multicentre, double-blind comparative study was performed to compare the effects of trimetazidine with diltiazem on exercise performance in patients with stable angina pectoris. Methods and results-A total of 116∞ ∞ male patients with documented coronary artery disease at 11 centres were randomized into trimetazidine and diltiazem groups both including 58∞ ∞ men (mean age 55.1∞∞±∞∞8.6∞∞years and 54.9∞∞±∞∞6.6∞∞years, respectively) in a prospective, multicentre, double-blind active treatment trial.The study consisted of a two-week placebo washout period and a four-week active treatment phase. Clinical examinations and exercise tests were performed at the beginning (D0) and at the end (D28) of the active treatment. Laboratory investigations were also performed at the beginning of the washout period (D-14) and at D28. Holter recordings were done in the mid of the washout period (D-7) and D28. Both trimetazidine and diltiazem decreased the number of anginal attacks per week (p∞ ∞ <∞ ∞ 0.0001 for both drugs) and weekly nitrate consumption (p∞ ∞ =∞ ∞ 0.0008 and p∞ ∞ <∞ ∞ 0.0001, respectively). Both trimetazidine and diltiazem improved the recovery of anginal pain (p∞∞=∞∞0.0188 and p∞∞=∞∞0.0079, respectively) and maximal ST-segment depression (p∞∞=∞∞0.0134 and p∞ ∞ =∞ ∞ 0.0214, respectively) but none of the drugs significantly changed the time to 1 mm ST-segment depression and ST recovery time on exercise test. Diltiazem caused a slight prolongation of PR and QRS durations (p∞ ∞ =∞ ∞ 0.039) on ambulatory ECG whereas trimetazidine did not change these parameters significantly. Conclusion-This study suggests that trimetazidine is an effective and safe alternative for diltiazem in the treatment of patients with stable angina pectoris. Although several other trials have shown that this drug can be used in combination with other antianginal drugs or instead of beta blockers or nifedipine in the symptomatic treatment of stable anginal syndromes, this study suggests that trimetazidine can be used instead of diltiazem, a well-known powerful antianginal drug.

The purpose of this study was to determine the prevalence of renal artery stenosis in patients with suspicion of coronary heart disease and hypertension referred for diagnostic coronary angiography. The study material was consisted of 186 (65 females, 121 males; the mean ...

Objective: To present our series of patients with mitral valve prolapse (MVP), underlining the clinical features and outcome of such patients, and 2. To focus the role of multiple echocardiographic parameters on its evaluation and severity. Methods: Retrospective analysis of children with MVP, hospitalized or examined at University Children's Hospital, Prishtina-echo lab., between 2000/2007. Study group consists of 77 children with MVP, aged from 12 mo to 18 years. The diagnosis of MVP was established using only non invasive techniques, such as: history, clinical status, ECG, chest X ray and 2D, color Doppler. Following recommendations of the American Society of Echocardiography, six qualitative and quantitative parameters are also used for assessing mitral valve regurgitation: regurgitant jet area, vena contracta, proximal isovelocity surface area (PISA), pulmonary artery pressure, pulmonary venous flow pattern and left atrium size. Results: The number of children with MVP was 77. There were 45 (58.5%) female and 32 (41.5%) male patients, with male:female ratio 1:1.4. There was found wide spectrum of clinical manifestations in diagnosed patients with MVP. Patients with mitral valve dysplasia, without regurgitation weren't excluded from this study. Using mentioned criteria, the mitral regurgitation quantification has been calculated, as: mild in 37 pts (48.0%), moderate in 31 (40.0%) and severe regurgitation in 9 (12.0%). 2. In a mitral valve prolapse group consisting of 63 pts, 28 (44.4%) belong to a mild, 26 (41.3%) to a moderate and 9 (14.3%) to a severe regurgitation group. The youngest children with MVP were 12 mo and 16 mo, respectively. The first patient died because of severe mitral regurgitation and heart failure. The second patient had also very bad mitral valve coaptation following by severe mitral regurgitation. He underwent two interventions: firstly, mitral anuloplasty was performed, but the child developed severe, recurrent haemolytic anemia and then the mitral valve replacment was done. About 45% of patients with MVP were asymptomatic, while the remaining 55% manifested different symtpms, like: rrythm disturbances, precordial pain, migrena etc. Infective endocarditis was established in two patients. Conclusions: Multiple, echocardiographic parameters were very useful in the evaluation of MR in pts with MVP, helping in minimizing the effects of technical or measurement errors that are inherent to each, single method. Early diagnosis can detect and treat even severe cases.

Bu çalışma akut miyokard infarktüsünde (AMİ) sirkadiyen ritm ve buna etkili faktörleri incelemek için yapıldı. İstanbul Üniversitesi Kardiyoloji Enstitüsü Yoğun Bakım Ünitesine 1 yıllık süre içinde akut miyokard infarktüsü (AMİ) tanısı ile yatan 266 erkek, 52 kadın toplam 318 hastanın AMİ'de ağrı başlangıç saati ile yaş, cinsiyet; hi

Background The use of N-acetylcysteine or theophylline in specific subgroups of patients has been suggested to reduce the incidence of contrast-induced nephropathy (CIN) in patients undergoing angiographic procedures. Our purpose was to compare the use of N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of CIN. Materials and methods We randomized 217 patients with estimated glomerular filtration rate (eGFR) (calculated by Modification of Diet in Renal Disease formula) between 30 and 60 mL min)1 1AE73 m)2 who were undergoing coronary angiography to three prophylactic treatment groups: Group 1: Intravenous hydration with isotonic saline (1 mL kg)1 h)1 for 12 h before and after contrast, n = 72). Group 2: Intravenous hydration with isotonic saline (1 mL kg)1 h)1 for 12 h before and after contrast)+ N-acetylcysteine (600 mg p.o. twice daily the preceding day and the day of angiography, n = 73). Group 3: Intravenous hydration with isotonic saline (1 mL kg)1 h)1 for 12 h before and after contrast)+ N-acetylcysteine + theophylline (600 mg N-acetylcysteine p.o. and 200 mg theophylline p.o. twice daily for the preceding day and the day of angiography, n = 72). The incidence of CIN (0AE5 mg dL)1 increase in serum creatinine from the baseline value 48 h after intravascular injection of contrast) was compared in three groups. Results Of the 217 patients, 12 patients (5AE5%) experienced CIN. Five patients (6AE9%) in group 1, seven patients (9AE6%) in group 2 and zero (0%) patients in group 3 experienced CIN (P < 0AE033). Conclusion Among patients with eGFR between 30 and 60 mL min)1 1AE73 m)2 undergoing coronary angiography, oral administration of N-acetylcysteine + theophylline in addition to saline hydration has a beneficial effect in the prevention of CIN.

Bidirectional flow in patients with normal coronary arteries is an indicator of intercoronary continuity, a rare variant of coronary circulation, distinct from collaterals. The case of an 18 year old Turkish male with bicuspid aorta and intercoronary artery is reported and different aspects of this interesting entity are emphasized.

In this study we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma glutamyl transferase (GGT), uric acid and coronary artery ectasia (CAE) in a large patient population. Methods: A total of 406 patients (245 male, mean age 55AE9 years) were selected as study population in a retrospective manner from 3265 individuals who have undergone coronary angiography between August 2011 and December 2012. Study population was consisting of four groups including 117 (%29) patients with isolated CAE, 109 (%27) patients with both CAE and severe stenosis in at least one coronary artery, 104 (%26) patients with isolated significant coronary stenosis and 76 (%18)patients with normal coronary arteries (NCA) as control group. Detailed evaluation of all coronary angiograms was performed by two experienced interventional cardiologist. Information regarding blood tests of patients obtained during hospitalisation were extracted from Institute electronic database. Results: MPV, GGT, and uric acid levels were significantly higher in subjects with stenotic coronary artery disease (CAD) and in subjects with both CAD and CAE compared with subjects with isolated CAE and subjects with NCA. There were no significant differences between subjects with isolated CAE and NCA groups in terms of MPV (8.6AE1.2 fL to 8.6AE1.1, p¼0.993), serum GGT (33AE15 U/L to 30AE15 U/L, p¼0.723) and uric acid levels (5.4AE1.6 mg/dl to 5.2AE1.7 mg/dl, p¼0.845). Conclusıon: Unlike with previous studies our study failed to demonstrate any association between CAE and MPV, uric acid and GGT levels.

Left ventricular outflow tract pseudoaneurysm is a rare but a potentially lethal complication, mainly after aortic root endocarditis or surgery. Usually, it originates from a dehiscence in the mitral-aortic intervalvular fibrosa and arises posteriorly to the aortic root. We report a rare case of a patient with cardiac tamponade due to left ventricular pseudoaneurysm after aortic valve replacement. The subsequent surgical resection was performed successfully.

Aim Spontaneous reperfusion (SR) was associated with better clinical outcomes and lower incidence of major adverse cardiovascular events. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and elevated systemic ET-1 levels predict a poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the relationship between systemic ET-1 plasma levels and SR in a group of STEMI patients treated with a primary percutaneous coronary intervention (PCI). Methods and results We measured ET-1 levels acutely (within the first 6 h) in 33 STEMI patients with SR and 45 STEMI patients with non-SR presenting with their first STEMI who underwent primary PCI. Blood samples for ET-1 plasma level measurement were drawn after vascular puncture before angiography in the catheterization laboratory from the peripheral vein. The mean age of the patients was 56.1 ± 13.3 years in the SR group and 57.4 ± 11.4 years in the non-SR group. The circulating level of ET-1 was considerably higher in the non-SR patients than in the SR patients (0.81 ± 0.2, 1.0 ± 0.3, P = 0.004). On multivariable logistic regression analysis, the ET-1 level was the only significant predictor of SR (P = 0.01). The receiver operating characteristic curve analysis showed that the ET-1 level at admission is an indicator of SR, with an area under the curve of 0.62. Conclusion This study shows that in patients admitted with ST-elevation acute myocardial infarction, ET-1 plasma levels are related to angiographic SR before primary PCI.