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Abstract: Background: Inflammation is one of the key mechanism in the development and progression of coronary artery disease. Myocardial bridging (MB) increases the tendency for development of atherosclerosis. The role of inflammation on the development of atherosclerosis in the MB is not clear. In this study, we investigated the existence of inflammation in the patients who have atherosclerotic plaque in the bridged segment. Methods: This study included 40 patients (group I) presented with stable angina pectoris and detected MB in LAD on coronary angiography and 30 control subjects (group II) with normal coronary angiogram. Patients in group I were divided into two subgroups based on the findings on intravascular ultrasound (IVUS): group IA included 25 patients without atherosclerotic lesion in any coronary artery and group IB included 15 patients with atherosclerotic lesion in addition to MB in bridged segment of LAD. High-sensitivity C-reactive protein (hs-CRP) levels were compared between group I and II and group IA and IB. Results: IVUS showed an atherosclerotic involvement with the proximal segment of MB in 15 patients (=group IB). No plaques were seen in other coronary arteries, in distal of MB or in the bridged segment. With regards to the level of hs-CRP, while no difference was established between group I and group II (1.7±0.4 mg/L vs 1.9±0.6 mg/L, p >0.05), hs-CRP was significantly higher in group IB than in group IA (3.2±0.3 mg/L vs 1.5±0.2 mg/L, p =0.001) and control group (3.2±0.3 mg/L vs 1.9±0.6 mg/L, p =0.03). A significant positive correlation was detected between the hs-CRP and the percentage of atherosclerotic stenosis on IVUS in group IB (R =0.639, p =0.01). Conclusions: These results indicate the presence of a low grade inflammation in patients with atherosclerotic lesion in bridged segment. [Copyright &y& Elsevier]

Abstract: Background: Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E′ ratio as a non-invasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner. Methods: Patients with an LVEF<40% admitting with acute heart failure attack with ischemic origin were included to this study. Patients were randomized to levosimendan (n =30, mean age: 64±10 years, 63% male) or dobutamine (n =32, mean age: 66±8 years, 54% male) groups. The ratio of the peak E wave velocity taken from mitral inflow with PW Doppler to the peak E′ wave velocity taken from mitral lateral annulus with tissue Doppler was determined. Pre-treatment and 24-hour after the treatment E/E′ ratios were calculated and then compared in both groups. Results: Age, gender, concomitant medications were similar in both groups (p >0.05). There was no difference for pre-treatment baseline E/E′ ratios between levosimendan and dobutamine groups (15.7±4.0 vs 15.2±7.5 respectively, p =0.1). There were significant reductions in post-treatment E/E′ ratios in levosimendan (15.7±4.0 vs 9.3±2.8, p =0.01) and dobutamine groups (15.2±7.5 vs 12.9±5.6, p =0.04). However, the reduction in levosimendan group was greater compared to dobutamine group (p =0.01). Conclusions: Levosimendan causes a greater reduction of E/E′ ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure. [Copyright &y& Elsevier]

Abstract: To determine the effect of functional performance, respiratory function, and osteopenia on the quality of life after heart transplantation. Thirty-one patients were included. Functional performance (peak oxygen consumption — pVO2), respiratory function, quality of life (the short form 36 — SF36) and lumbar spine and hip bone mineral density (BMD) were performed. There was a significant relationship between pVO2 and physical function and the physical role scores on the SF36 (p <0.05). Additionally, a significant relationship was found between the scores on the respiratory function tests and the physical and social function scores on the SF36 (p <0.05). There was no significant relationship found between osteopenia and SF36 scores (p >0.05). [Copyright &y& Elsevier]