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A considerable fraction of collaterals has been shown to regress immediately after percutaneous transluminal coronary angioplasty (PTCA), but the fate of these well-developed collaterals is unknown. The authors aimed to show the protective role of these recruitable collaterals in case of an acute myocardial infarction (MI). They identified 22 patients who underwent PTCA and then were rehospitalized owing to acute myocardial infarction. These patients were compared with a group consisting of 48 patients hospitalized owing to acute MI without a history of previous PTCA. Then, the patients with collaterals were compared with the patients without collaterals to define the factors affecting the collateral formation. All the patients with collaterals before PTCA were shown to have collaterals also after AMI, and collateral grades were greater after MI (1.67 +/-0.98) when compared with those before PTCA (0.73 +/-0.7) (p = 0.001). Coronary collaterals were more commonly seen in patients with a history of previous PTCA (p = 0.005), and the grades of collaterals were also higher in these patients when compared with those without PTCA. Left ventricle score indices were lower and left ventricular ejection fractions (LVEF) were higher in patients with a history of PTCA (p = 0.001). Logistic regression analysis revealed that smoking increased the development of collaterals after AMI 3.8 fold, aspirin use 4.1 fold. On the contrary, diabetes mellitus (DM) decreased this 6.67 fold. As a result, well-developed coronary collaterals are preserved even if they have regressed after restoration of flow, and they may become functional and protect the myocardium against acute ischemia. [ABSTRACT FROM AUTHOR]

Although cardiovascular manifestations in thyroid disorders are frequently encountered in clinical practice, atrioventricular (AV) conduction disorders, especially in hyperthyroidism, are rare. There are some proposed mechanisms for AV blocks in hyperthyroidism but the exact mechanism is still unknown. The authors report 2 cases with thyroid function disorders and complete AV block, and the electrophysiologic characteristics of these 2 patients, and they review and speculate on similar reported cases. [ABSTRACT FROM AUTHOR]

The CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, female gender) score is used to estimate thromboembolic risk in atrial fibrillation (AF). Its usefulness in predicting in-stent restenosis (ISR) is unknown. We evaluated the predictive value of the CHA 2 DS 2 -VASc score in AF-free patients who have undergone stent implantation. A total of 1350 patients who underwent coronary angiography and successful bare-metal stent implantation were analyzed. The CHA 2 DS 2 -VASc score was calculated before percutaneous coronary intervention, and the association between the score and ISR was investigated. Patients (n = 700; mean age: 61.4 [8.7] years, 63% men) were divided in 2 subgroups according to the presence of ISR; 265 of 700 patients had ISR. Mean CHA 2 DS 2 -VASc score was significantly higher in the ISR (+) group than the ISR (-) group (3.7 [1.8] vs 2.1 [1.4], P < .001). According to multivariate logistic regression analysis, diabetes, hyperlipidemia, smoking, stent length, and CHA 2 DS 2 -VASc score were independent predictors of ISR. In conclusion, the CHA 2 DS 2 -VASc score may be useful as a new and simple tool to predict ISR.

We assessed the prognostic value of the platelet to lymphocyte ratio (PLR) on in-hospital and long-term major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in a large prospective study. Patients (n = 1938) admitted with acute STEMI within 12 hours of symptom onset and who underwent pPCI between January 2010 and January 2015 were followed up for 31.6 ± 16.2 months. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, nonfatal myocardial infarction, and mortality were higher in the third PLR tertile group. A PLR in the third tertile had 2.4-fold increased risk of in-hospital MACE and 2.8-fold risk of long-term MACE. The PLR was significantly and positively correlated with peak creatine kinase MB (CK-MB) levels (r = 0.562, P < .001) and Gensini score (r = 0.408, P < .001). Kaplan-Meier analysis of long-term MACE-free survival revealed a higher occurrence of MACE in the third PLR tertile group compared to the other tertiles. In conclusion, the PLR may be a marker of inflammatory and prothrombotic status and predicted in-hospital and long-term MACE in a population with STEMI., (© The Author(s) 2015.)

We investigated the relationship between epicardial adipose tissue (EAT) and infarct-related artery (IRA) patency before mechanical reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Patients (n = 640) were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow grade. Impaired flow was defined as TIMI grades 0, 1, and 2, and normal flow was defined as TIMI 3. On the admission angiography, 65 (10.2%) patients had TIMI 3 flow, and the remaining 575 (89.8%) had TIMI 0, 1, or 2 flow. The impaired flow group patients had a higher incidence of diabetes mellitus (53.7% vs 41.5%, P = .035), higher EAT thickness (5.66 ± 1.84 vs 4.87 ± 2.09 mm, P = .001), and lower ejection fraction (43.1% ± 8.9% vs 47.4% ± 9.1%, P = .025). Multivariate stepwise logistic regression analysis showed that IRA patency was independently associated with EAT thickness (odds ratio [OR] 0.785; 95% confidence interval [CI] 0.712-0.858; P = .001) and neutrophil-lymphocyte ratio (OR 0.815; 95% CI 0.732-0.917; P = .025). Thickness of EAT was an independent predictor of lower TIMI flow in IRA in patients with STEMI., (© The Author(s) 2015.)

The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker. Hence, we assessed the relationship between PLR and the extent/severity of coronary artery disease (CAD) using the Gensini score in association with the inflammatory marker C-reactive protein (CRP) in patients with stable CAD. Angiographic data of 1646 patients were analyzed in this cross-sectional study. Patients were categorized according to Gensini scores as no CAD (control), mild, and severe CAD groups. The PLR in the control group was significantly lower than those of mild and severe CAD groups. In multivariate logistic regression analysis, PLR was found to be an independent predictor of the presence of severe CAD (odds ratio: 1.043 [1.036-1.049], P < .001). Furthermore, there was a significant correlation between PLR and the severity of CAD (r = .370, P < .001) and CRP levels (r = .312, P < .001). In conclusion, PLR was independently and positively associated with the severity of coronary atherosclerosis. These results suggest that PLR is an easily available and cheap inflammatory indicator that can be used in predicting the severity of CAD., (© The Author(s) 2015.)

Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis. The aim of this study was to evaluate the association between the severity of preoperative functional TR and late adverse outcomes in patients undergoing mitral valve replacement (MVR). The study group comprised 68 patients (54 women, 14 men; mean age 45 +/-10 years) with rheumatic mitral stenosis (MS) who had undergone MVR without tricuspid valve surgery between 4 and 13 years (mean 8.1 +/-2.6 years) before their last clinical examination. All patients underwent a complete preoperative and late postoperative color-Doppler echocardiographic examination. The severity of TR was assessed echocardiographically by using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins. Patients were classified into 2 groups; 42 with mild (62%) and 26 with significant (38%) TR. Patients with significant TR showed longer preoperative symptomatic period and more atrial fibrillation than those with mild TR. All patients had medical treatment. Functional capacity and NYHA class of the patients in both groups improved significantly after MVR. Freedom from symptomatic heart failure (functional class III or IV) was higher (86% vs 54%) and the need for hospitalization was significantly lower for the mild TR group. Significant preoperative functional TR diagnosed by echocardiography was associated with an adverse outcome. Therefore, further studies are needed to evaluate the effect of concomitant tricuspid valve repair on the late outcome of patients undergoing mitral valve surgery in order to prevent significant late morbidity.

Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p < 0.05). Whether the rhythm was sinus or AF, fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly higher in patients with LASEC than in the control group (p < 0.05). Only PF 4 was higher in the AF group than in those with sinus rhythm (p < 0.05). As to plasminogen activator and PAI-I levels, only tissue plasminogen activator levels were found to be higher in the AF group than in those with sinus rhythm and the control group (p < 0.05). In patients with mitral stenosis and sinus rhythm, if LASEC is present, coagulation activation, platelet activation, and endothelial dysfunction are similar in patients with AF, and anticoagulation should be considered in these patients.