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Objective: The present study was an investigation of the relationship between fragmented QRS (fQRS) and left ventricular apical thrombus (LVAT) in patients presenting with first acute anterior myocardial infarction (MI)., Methods: Consecutive 148 patients (mean age: 60.1±10.1 years; male: 75.6%) with first acute anterior MI who underwent primary percutaneous coronary intervention (PCI) were included. Study population was divided into 2 groups based on presence of LVAT. fQRS was defined as presence of various RSR' patterns, which included additional R wave or notching of R wave or S wave, and presence of more than 1 R in 2 contiguous leads corresponding to major coronary artery territory on 12-lead electrocardiogram. Patients with bundle branch block were excluded from the study., Results: Of these, 32 (21.6%) had LVAT. Patients with LVAT had higher prevalence of fQRS (53.1% vs. 22.4%; p<0.001) and lower rate of successful PCI (75% vs. 94%; p=0.002) compared with patients without LVAT. More patients in LVAT group had left ventricular ejection fraction of <30% (87.5% vs 65.5%; p=0.010). Groups were similar with respect to other baseline characteristics (p>0.05 for all). Presence of fQRS was independent predictor of LVAT (odds ratio [OR], 2.795; 95% confidence interval [CI], 1.058-7.396) in multivariable logistic regression analysis., Conclusion: Presence of fQRS in leads V4-V6 is independently associated with LVAT in patients presenting with first acute anterior MI.

We report a 68-year-old man who presented with heart failure and atrial fibrillation (AF) with rapid ventricular response and wide QRS complexes. Tachycardia-induced cardiomyopathy (TIC) due to persistent AF developing on the basis of Wolff-Parkinson-White (WPW) syndrome was considered. Signs and symptoms of heart failure improved with restoration of sinus rhythm. This case suggested that persistent AF in a patient with WPW syndrome is one of the rare causes of TIC.

Objectives: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain., Study Design: A total of 540 patients (350 male, 190 female; mean age: 59.6±11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated., Results: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5±0.1 fl, 8.5±1.2 fl, 8.6±0.9 fl and 8.6±0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values., Conclusion: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.

Objectives: We evaluated the role of admission high-sensitivity C-reactive protein (hs-CRP) level in estimating myocardial perfusion and in-hospital adverse events in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI)., Study Design: The study included 43 consecutive patients (34 males, 9 females; mean age 59+/-11 years) who underwent PCI for STEMI within six hours after the onset of symptoms. Coronary angiograms were evaluated with respect to TIMI flow grade, corrected TIMI frame count, and myocardial blush grade (MBG). Electrocardiograms obtained 90 min after PCI were analyzed for ST-segment resolution. In-hospital adverse events were recorded. hs-CRP level was measured by immunonephelometry in blood obtained immediately before PCI., Results: The mean hs-CRP level was 1.35+/-1.17 mg/dl. Based on the median hs-CRP value (0.98 mg/dl), 22 patients with a low hs-CRP level had a lower frequency of hypertension (p=0.047), decreased TIMI frame counts of the left anterior descending (p=0.010) and circumflex (p=0.033) arteries, a higher rate of ST resolution (p=0.000), improved MBG (p=0.015), and shorter hospitalization (p=0.028). Adverse events occurred in six patients (14%), in five of whom (5/21) the hs-CRP level was above 0.98 mg/dl. hs-CRP was significantly correlated with corrected TIMI frame counts of the left anterior descending (r=0.388, p=0.01) and circumflex arteries (r=0.336, p=0.027), length of hospitalization (r=0.357, p=0.019), and inversely correlated with MBG (r=-0.415, p=0.006). In multivariate regression analysis, hs-CRP was found to be an independent predictor of ST resolution (p=0.008). ROC analysis showed that a higher level of hs-CRP than 0.88 mg/dl predicted poor MBG with 73% sensitivity and 31% specificity (95% CI 0.577-0.899, p=0.01)., Conclusion: In STEMI patients undergoing primary PCI, high levels of admission hs-CRP are associated with poor myocardial perfusion and longer hospitalization.

Objectives: It has been shown that asymmetric dimethylarginine (ADMA), an endogenous competitive antagonist of nitric oxide (NO) synthase, inhibits angiogenesis by reducing the production and bioavailability of NO. We investigated the effect of plasma ADMA level and L-arginine/ADMA ratio on the development of coronary collateral arteries., Study Design: The study consisted of 94 patients (66 males, 28 females; mean age 59+/-11 years) who underwent coronary angiography for suspected coronary artery disease and were found to have severe stenosis (>95%) in at least one major coronary artery. The patients were evaluated in two groups with poor (Rentrop score 0-1, n=44) and good (score 2-3, n=50) coronary collateral circulation according to the Rentrop collateral scoring system. Plasma levels of ADMA and L-arginine were measured by high-performance liquid chromatography., Results: The two groups were similar with regard to basal characteristics and cardiovascular risk factors (p>0.05) except for stable angina, which was more common in patients with Rentrop score 2-3 collateral circulation (p<0.001). Despite similar L-arginine levels (p>0.05), patients with Rentrop score 0-1 had a significantly higher ADMA level (p=0.003) and lower L-arginine/ADMA ratio (p=0.019). Multivariate logistic regression analysis showed that plasma ADMA concentration was an independent predictor of coronary collateral development (odds ratio=0.674; 95% confidence interval=0.508-0.894; p=0.006)., Conclusion: Elevated plasma ADMA concentrations are associated with a poorly developed coronary collateral circulation, suggesting that dysregulation of the NO synthase pathway may result in impaired collateral development.