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Background: Inflammatory mechanisms play an important role in both atherosclerosis and stroke. There are several inflammatory peripheral blood count markers associated with carotid artery stenosis degree, symptomatic carotid artery lesions and carotid artery stent restenosis that reported in previous studies. However, the prognostic role of the blood cell counts and their ratios in predicting in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS) has not been comprehensively investigated. Systemic immune-inflammation index (SII) proved its' efficiency in patients with solid tumors and its' role was rarely examined in cardiovascular disorders and stroke. The current study evaluated the effect of this novel risk index on in-hospital and long-term outcomes in a large patient population who underwent CAS. Method: A total of 732 patients with carotid artery stenosis who underwent CAS were enrolled to the study. SII was calculated using the following formula: neutrophil-to-lymphocyte ratio pound total platelet count in the peripheral blood (per mm3) and the patients were stratified accordingly: T1, T2 and T3. In-hospital and 5-year outcomes were compared between the tertiles of SII. Results: During the hospitalization, major stroke, ipsilateral stoke, myocardial infarction, death and major adverse cardiovascular events (MACE) rates were significantly higher in high SII level (T3) compared to SII levels (T1 and 2). In longterm outcomes, ipsilateral stroke, major stroke, transient ischemic attack, death, and MACE were significantly higher in the patients with higher SII level (T3). The 5-year Kaplan-Meier overall survival for T1, T2, and T3 were 97.5%, 96.7% and 86.0% respectively. In-hospital and 5-year regression analyses demonstrated that high SII was independently associated with MACE and mortality. Conclusion: SII was independently associated with in-hospital and long-term clinical outcomes in patients undergoing CAS. Immune and inflammation status, as assessed easily and quickly using SII, has a good discriminative value in these patients. WOS:000686903400007 2-s2.0-85109196298 PubMed: 34242858

OBJECTIVES: This study aims to evaluate the effect of cardiac rehabilitation (CR) on disease activity, functional status, fitness, and modified cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA) with a moderate disease activity. PATIENTS AND METHODS: This single-center, controlled study included a total of 60 female RA patients (mean age 57.5 years; range, 50 to 64 years) with moderate disease activity according to the Disease Activity Score-28 (DAS28) between January 2014 and June 2015. The patients were divided into two equal groups as those receiving CR program (n=30) and those receiving home exercise program (HEP; n=30). The patients were evaluated at baseline, at Weeks 10 and 24 using exercise tolerance test (i.e., The Metabolic Equivalent of Task [MET] and maximal oxygen uptake [VO2 max]), Six-Minute Walk Test (6MWT), DAS28, Health Assessment Questionnaire (HAQ), modified Systematic Coronary Risk Evaluation (mSCORE), Short Form Health Survey-36 (SF-36), and Beck Depression Inventory (BDI). RESULTS: There was a significant improvement in the VO2 max (p

Takayasu's arteritis (TA) is a rare idiopathic inflammatory condition that predominantly involves the aorta and its branches causing narrowing and aneurysms in vessels. In this case report, we present TA with a rare coexistence of aortic pseudocoarctation and anterior mitral leaflet perforation with moderate regurgitation.

Introduction: Procoagulant activity of heparanase has been recently described in several arterial and venous thrombotic disorders. In this study, we aimed to investigate the role of heparanase with regard to thrombus burden, thromboembolism, and treatment success with unfractionated heparin (UFH) in patients with prosthetic valve thrombosis (PVT). Methods: This study enrolled 79 PVT patients who received UFH for PVT and 82 controls. Plasma samples which were collected from patients both at baseline and after the UFH treatment and from controls at baseline only, were tested for heparanase levels by heparanase enzyme-linked immunosorbent assay. Results: The PVT group included 18 obstructive and 61 non-obstructive PVT patients who received UFH infusions for a median duration of 15 (7–20) days. The UFH treatment was successful in 37 (46.8%) patients. Baseline heparanase levels were significantly higher in the patient group than in the controls [0.29 (0.21–0.71) vs. 0.25 (0.17–0.33) ng/mL; p = 0.002]. Baseline heparanase levels were significantly higher in obstructive PVT patients. There was a significant increase in heparanase levels after UFH treatment. Post-UFH heparanase levels were higher in patients who experienced treatment failure compared to successfully treated group. Baseline and post-UFH heparanase levels were significantly higher in patients with a thrombus area >=1 cm2 and with a recent history of thromboembolism. Conclusions: Increased heparanase levels may be one of the esoteric causes for PVT. UFH treatment may trigger an increase in heparanase levels which may affect the treatment success. Increased heparanase levels may be associated with high risk of thromboembolism and increased thrombus burden in PVT patients. © 2018 Elsevier Ltd

We report the administration of low-dose (25 mg) prolonged infusion (25 h) of tissue-typed plasminogen activator (t-PA) in the treatment of brachial arterial thromboembolism (BAT) secondary to prosthetic valve thrombosis (PVT), under the guidance of multimodality imaging. BAT is a rare disorder with serious consequences. The case of BAT secondary to mitral PVT was successfully treated with low-dose prolonged infusion of t-PA under the guidance of multimodality imaging with upper extremity duplex Doppler ultrasonography, multislice computerized tomographic angiography, coventional angiography and advanced transesophageal echocardiography. This case has demonstrated that low-dose prolonged infusion of t-PA may be adequate in the treatment of BAT.

We have read with great interest the letter to the Editor entitled “Prosthetic valve thrombosis: when prevention is better than treatment” authored by Tarzia et al. They aimed to emphasize the role of ultrasound phonocardiography in early detection of mechanical prosthetic valve thrombosis (PVT), which could have an impact on prognosis of the patient. Despite the great improvements in technology over the past 4 decades, PVT has been associated with a significant death risk. Therefore, diagnosis and management of PVT are crucial, especially in the developing countries where this condition is prevalent. Transthoracic echocardiography is usually the first imaging modality to evaluate suspected PVT, but it is limited in evaluating valve mobility and mechanism of valvular obstruction. Transesophageal echocardiography, especially real-time (RT) handling of 3-dimensional information, has been a milestone in the era of cardiovascular imaging of both native and prosthetic valves. Real-time 3-dimensional transesophageal echocardiography provides better visualization of the atrial and ventricular sides of the prosthesis, improves understanding of the relation between cardiac structures, and helps in discriminating pannus from thrombus. Cinefluoroscopy is a noninvasive, readily available method for detecting PVT, especially in patients with bileaflet prosthetic valves, and plays a complementary diagnostic role in evaluating disk mobility of the prosthesis. Multislice computed tomography has also been proven to be a useful tool in the differential diagnosis of prosthetic valve dysfunction including PVT and pannus. Briefly, multimodality imaging is usually required for exact diagnosis of PVT. As Tarzia et al have stated, an early detection of thrombotic formations appears decisive for patient's prognosis. We appreciate their effort to detect early PVTwith the utility of in vitro and in vivo ultrasound phonocardiographic analysis of the closing sound produced by several mechanical heart valves. They could be able to distinguish functional and dysfunctional prosthesis, differentiating obstructive from nonobstructive forms and identify precocious apposition of minimal thrombi in several different type of prostheses. We completely agree with the authors that prevention of PVT is crucial for avoiding future catastrophic outcomes. Analysis of the prosthetic valves with artificial neural network and ultrasound phonocardiography could provide essential clues for early detection of PVT.

Fibrinogen is related to the pathogenesis of atherosclerosis. The inflammatory process in atherosclerosis may cause an increase in plasma fibrinogen level. Therefore, in this study we proposed to investigate whether plasma fibrinogen is associated with the patency of saphenous vein graft in patients at least 1 year after coronary artery bypass graft (CABG) surgery.Patients who had undergone CABG surgery at least 1 year previously with at least one saphenous vein graft were included in the study. Patients were directed to cardiac catheterization for stable anginal symptoms or positive stress test results. Before coronary angiography, all patients underwent routine blood tests including assessment of plasma fibrinogen levels.Saphenous vein grafts were found to be patent in 199 patients and occluded in 132 patients. Plasma fibrinogen levels were significantly different between the two groups (2.85 ± 0.49 g/L vs. 3.62 ± 0.82 g/L, p0.001, respectively). Although the time duration after CABG operation differs significantly between the two groups (p = 0.004), multiple logistic regression analysis showed that plasma fibrinogen levels were found to be significantly associated with the patency of vein graft (odds ratio = 0.27, 95% confidence internal: 0.16-0.48, p0.001).Our results demonstrated that plasma fibrinogen levels were higher in patients with an occluded saphenous vein graft. To conclusively prove the relationship between plasma fibrinogen values and saphenous vein graft patency, additional investigation would be necessary.Atherosclerosis; Coronary artery bypass graft; Fibrinogen; Saphenous vein.