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Background: Up to 30% of patients with acute pericarditis develop recurrent pericarditis. Acute pericarditis may be a manifestation of an underlying systemic autoimmune disease. Therefore, we evaluated the characteristics of patients with acute pericarditis according to antinuclear antibodies (ANA) positivity/negativity. Methods: Participants with acute pericarditis and negative ANA (n=29), recurrent pericarditis with positive ANA (n=30) and healthy controls (n=11) were examined. The groups were compared using serum parameters (ANA, C-reactive protein, leucocyte count, erythrocyte sedimentation rate, total antioxidant status, nitric oxide (NO), and oxidative stress index (OSI)) and imaging techniques (electrocardiogram, echocardiography, cardiovascular magnetic resonance, and venous Doppler ultrasound). Results: In females, acute pericarditis associated with ANA occurred more frequently (p Conclusion: This study suggests that acute pericarditis associated with ANA is more common in middle- aged females. SVF and lower oxidative stress tests were more common in patients with ANAassociated acute pericarditis. Acute pericarditis associated with ANA could be considered as a hypercoagulable state. Therefore, all newly diagnosed pericarditis patients (especially females) should be checked for ANA positivity. Awareness of this coexistence should be promptly addressed to establish management strategies.

Cardiac 3-dimensional printing for pre-procedural planning of structural heart procedures is a promising new tool. Despite current potential drawbacks, 3-dimensional models can help cardiologists better understand and treat complex cardiac defects. We describe a successful coronary cameral fistula closure planned with the aid of a 3-dimensional model. (Level of Difficulty: Advanced.), Graphical abstract, Cardiac 3-dimensional printing for preprocedural planning of structural heart procedures is a promising new tool. Despite current potential drawbacks…

WOS: 000442902500007, Background: Smoking cessation is potentially the most effective secondary prevention measure and improves prognosis after acute ST-segment elevation myocardial infarction (STEMI), but more than half of the patients continue to smoke after STEMI. The awareness of the disease's severity and the short hospital stay at the index STEMI have been found to be associated with persistent smoking after STEMI. Objective: To assess whether the paradoxical relationship between smoking quitting rates and health-related quality of life (QOL) scores in STEMI patients undergoing primary percutaneous intervention (pPCI) by radial (RA) versus femoral approach (FA). Methods: Our population is represented by 138 STEMI patients undergoing pPCI by FA or RA. The smoking cessation rates and QOL scores were evaluated. Results: Patients at RA group (46 patients, 57 +/- 9 years, 87% male) had a higher European Quality of Life-5 Dimensions (EQ-5D) index score at post-PCI first week compared to FA group (92 patients, 57 +/- 8 years, 75% male) [FA: median 0.81 (0.22) vs. RA: 1 (0.22), p = 0.042], although it was similar at baseline [FA: median 1 (0) vs. RA: 1 (0), p = 0.992]. Total hospital length of stay [RA: median 3 (1) day vs. FA: 4 (1), p < 0.001] was significantly reduced in the RA group. Whereas the smoking cessation rates at 1-year post-discharge were 41% in RA group, it was 67% in FA group (p = 0.003). Female sex, pain-to-door time and RA during p-PCI were independent predictors of continued smoking after STEMI. Conclusion: This study shows that the smoking cessation was lower in RA group compared to FA group. The more comfortable conditions of STEMI management related to RA may cause a lower awareness of the disease severity and lower motivation to quit smoking. Therefore, it is important to inquire about smoking status at each clinical encounter, particularly in patients undergoing pPCI by the radial approach. (c) 2018 The Czech Society of Cardiology. Published by Elsevier Sp. z o.o. All rights reserved.

Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease such as atherosclerosis or cancer. Some authors speculated that atherosclerotic coronary artery disease (CAD) could be considered a “cancer of the coronary arterial wall”. Although the percutaneous coronary intervention (PCI) has proven to be effective in decreasing mortality rates among patients with acute coronary syndromes, the previous meta-analyses of PCI versus optimal medical therapy for stable CAD have not been able to demonstrate a reduction in major adverse cardiac outcomes. However, few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. Recently, the precision medicine is defined as an evidence-based approach that uses innovative tools and biological and data science to customize disease prevention, detection, and treatment, and improve the effectiveness and quality of patient care. Providing patients with accurate and complete information appears to be an effective way to combat the reliance on the oculostenotic reflex. The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. As said by Doctor William Osler, “The good physician treats the disease; the great physician treats the patient who has the disease.”

ObjectiveBuerger’s disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger’s disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions.MethodsA total of 16 consecutive patients with confirmed diagnosis of Buerger’s disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 ± 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to at least one of the blow-the-knee arteries.ResultsA successful extended endovascular treatment was performed in 20 of 22 limbs, achieving a technical success of 91%. All patients were successfully discharged without any complication. Mean follow-up duration was 21.43 ± 7.08 months. Reintervention was performed in one patient and minor amputation was needed in one of the failed limbs. Limb salvage rate was 100%. A significant difference was observed based on Rutherford classification, ankle brachial index, direct blood flow to foot, presence of ulcer and rest pain when compared before and after the intervention.ConclusionWe showed successful extended endovascular recanalization of Buerger’s disease patients with a high technical success rate and sustained clinical improvement. Extended endovascular recanalization could be a therapeutic option in Buerger’s disease patients, since they are not good candidates for surgery.

Introduction Coronary artery fistula consists of abnormal congenital connections between a coronary artery and cardiac chambers, a coronary vessel or an intrathoracic vessel that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques as an alternative to surgical closure, but the reported experience is relatively limited. Aim To assess angiographic outcomes in a series of 20 patients who underwent transcatheter closure of coronary artery fistula. Material and methods We evaluated all patients presenting with significant coronary artery fistula and undergoing transcatheter closure with coils and a vascular plug between March 2008 and June 2012. Results There were 20 patients (14 men; mean age: 53 ±8 years) with coronary artery fistula. Fistula diameter ranged from 4 to 12 mm; an average of three coils were used in the percutaneous procedure. Post-deployment angiograms demonstrated complete occlusion in all patients. The patients were followed up for 4 ±1.6 years. The control coronary computed tomographic angiography was performed in the sixth month and no patients had recanalization of the embolized vessel. Conclusions Percutaneous closure of coronary artery fistula is a safe and effective treatment modality.

Paravalvular leak (PVL), a serious complication of valve surgery, can be treated with percutanous techniques. In this article we present a case in which successful mitral PVL closure performed via transapical approach.

Objectives: In this article, our aims were to analyze and assess the data related to coronary revascularization rates, particularly in recent years. Study design: For this purpose, results of important studies, statistics of the Organisation for Economic Co-operation and Development (OECD) countries and data from Turkey's Social Security Agency (SSA) were analyzed for the first time. Until recently, there has been no healthy digital database regarding revascularization rates in Turkey. In the years following the establishment of SSA, it became possible to collect and analyze data obtained from the Medulla database of the Agency. Using the data from the Agency for the period 2009-2011, revascularization rates and cost analyses were performed. Results: Between 2000 and 2010 in European countries as well as in other OECD countries, the percutaneous coronary intervention (PCI) rate was on average 75% of the total revascularization rate and neared 80%. In some countries, the rate has exceeded 85%. In our country, in 2009, 2010 and 2011, the number of coronary angiography procedures and as a result PCI has steadily increased. The rate for PCI was 66.8% in 2009, but it increased to 74% in 2011. At the same time, PCI accounted for 2/3-4/5 of all revascularization procedures. In the cost analysis, however, PCI constituted only 1/5-1/4 of the costs of all revascularization procedures. Conclusion: This report is the first analysis in this area and it gives an initial idea about the current situation of the numerical and financial aspects. This analysis has provided the opportunity to obtain more accurate information about coronary revascularization rates in Turkey and to compare the data to that of other countries.

Calcified nodules in human coronary arteries are usually focally distributed. Non-invasive imaging of coronary arteries by bedside emergency transthoracic echocardiography in adults is possible and may become a useful adjunct to other methods of coronary artery examination. Coronary artery stenosis can be identified as localized color aliasing and accelerated flow velocities. Complete visualization of individual ostial coronary segments might ease the demonstration of coronary stenosis by bedside transthoracic echocardiography. The left main coronary artery stenosis requires prompt emergency evaluation and treatment because emergency conditions have higher mortality rates. The authors wish to emphasize the usefulness of emergency bedside echo-Doppler for a prompt diagnosis and treatment of this life-threatening condition.

Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Since some echocardiographic features play an important role in the assessment of the defect and safety of the procedure, the salient features of the anatomical variations seen in adults undergoing transcatheter device closure should be well known to prevent inadvertent adverse effect or complications. It has been reported that the valve of the inferior vena cava, Eustachian valve, could be mistaken as the atrial septum thus ending in a wrong diagnosis and causing inadvertent surgical or percutaneous closure of an Eustachian valve to interatrial septum. We present a concise article that brings out a practical issue encountered during device closure of atrial septal defects.

WOS: 000287060100005, In the current research, the total and free genistein and daidzein contents were determined in two endemic Genista species (G. sandrasica and G. vuralii) by an HPLC method. The highest amount of total genistein and total daidzein was found in G. sandrasica, 0.582 and 0.113 %, respectively, whereas only the free daidzein content of G. sandrasica was higher than that of G. vuralii. The antioxidant activity of the crude methanol and hydrolyzed extracts of these species was evaluated by three in vitro methods; namely DPPH free radical scavenging, ferrous ion-chelating and ferric-reducing antioxidant power (FRAP) tests at 0.25, 0.50, and 1.0 mg ml(-1). The hydrolyzed extracts of both species displayed greater antioxidant activity than the crude methanol extracts in all tests. Total phenol and flavonoid contents in the extracts were determined via the Folin Ciocalteau and AlCl3 reagents, respectively. G. vuralii was richer in terms of total phenol and flavonoid contents compared to G. sandrasica.

Both Brugada syndrome (BrS) and arrhythmogenic right ventricle dysplasia/cardiomyopathy (ARVD/C) can cause repolarization abnormalities in right precordial leads and predispose to sudden cardiac death (SCD) due to ventricular arrhythmias. Although there is controversy over whether BrS is distinct from ARVD/C, it is believed that both are different clinical entities with respect to both the clinical presentation and the genetic predisposition. The coexistence of these two relatively rare clinical entities is also reported, but, some hypothesized that it is more possible that disease of the right ventricular muscle might accentuate the Brugada electrocardiographic pattern. In clinic practice, there may be cases where the dividing line is not so clear. We report a 33-year-old male presenting with recurrent syncope, who has a peculiar pattern of coved-type ST-segment elevation (ST-SE) with epsilon-like wave in right precordial leads.

A 33‐y‐old man was admitted to the emergency department with sudden onset of severe substernal chest pain radiating to the left arm and neck. No pathological signs were recorded upon physical examination. The admission electrocardiogram (ECG) recorded during chest pain showed a large anterior wall myocardial infarction. Intravenous (IV) infusion of 1.5 million units of streptokinase over 1 h was initiated. Coronary angiography revealed total narrowing and flow interruption in the midsegment of the left anterior descending (LAD) coronary artery secondary to a myocardial bridge during systole and disappearance with diastole. He was discharged on aspirin (300 mg/d), metoprolol (100 mg/d), enalapril (10 mg twice daily), and atorvastatin (40 mg/d) treatment at the follow‐up period. Copyright © 2008 Wiley Periodicals, Inc.

Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. Methods and results A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4 ± 0.3 cm2, mean wilkins valve score value was 8.9 ± 1.7, left atrial diameter was 5.0 ± 0.7 cm, left atrial area was 37.2 ± 12.6 cm2, and systolic pulmonary arterial pressure (SPAP) was 44 ± 11 mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. Conclusions These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.

OBJECTIVE The present study was designed to analyse and compare the major coronary risk factors of female and male patients with premature coronary artery disease (CAD) aged < or = 45 years. METHODS We evaluated 4613 consecutive patients who underwent coronary angiography at our institution; 572 symptomatic patients (489 men and 83 women) diagnosed as having premature CAD (age < or = 45 years) were included in our analysis. For each patient, the presence of major coronary risk factors such as family history of CAD, hypercholesterolaemia, diabetes mellitus, hypertension and cigarette smoking were recorded. Besides, clinical presentation and angiographic findings were also recorded. RESULTS The most common risk factor was cigarette smoking in young men (70.3%). However, the major coronary risk factor was hypercholesterolaemia in young women (67.5%). When we compared two groups with respect to major coronary risk factors, we found that the prevalence of diabetes mellitus and hypertension were significantly higher in young women than in young men (diabetes mellitus: 27.7% vs. 12.3%, respectively, P < 0.001, hypertension: 56.6% vs. 23.4%, respectively, P < 0.001). However, cigarette smoking was found to be significantly higher in men than in women (70.3% vs. 28.9% respectively, P < 0.001). CONCLUSION We have shown for the first time the impact of gender on the coronary risk factor profile in young Turkish patients with premature CAD. These findings may be useful for gender-based management and risk factor modification of young patients with premature CAD.

BACKGROUND Atrial septal defect (ASD) is a common form of congenital heart defect in adults, which affects all cardiac chambers. Atrial myocardial function in patients with ASD has not yet been clearly elucidated. The aim of this study was to investigate atrial myocardial deformation properties in patients with ASDs. METHODS The study involved 24 patients with a secundum type ASD, and 22 healthy subjects. Color Doppler myocardial imaging was used to measure left and right atrial myocardial systolic strain and strain rate values, together with peak systolic velocity, early velocity, and late diastolic velocity. RESULTS There was no significant difference between the two groups with regard to age, gender, body mass index, heart rate, blood pressure, left atrial diameter, and ventricular function. The peak systolic atrial myocardial strain and strain rate values in each of the atrial walls studied were lower in the ASD group compared to those of the control group, but the difference reached statistical significance only in the case of the right atrial wall (right atrial strain: 48.0 +/- 32.7% vs 100.2 +/- 46.6%, P = 0.006; right atrial strain rate: 2.6 +/- 1.2/sec vs 3.8 +/- 1.2/sec, P = 0.024). CONCLUSION The left to right cardiac shunt that results from ASD leads to a reduction in the right atrial myocardial longitudinal lengthening that occurs during ventricular ejection. These findings demonstrate that the reservoir function of the atrium is impaired and atrial stiffness increases in patients with ASDs.

Background Coronary angiography is the gold standard for diagnosing coronary artery fistulas (CAFs). Multidetector computed tomography (MDCT) is a recently developed imaging technique for detecting coronary artery stenosis, coronary artery anomalies, and coronary artery fistulas and their courses. Objective We aimed to determine accuracy or sensitivity of MDCT in patients having CAF. Method We evaluated 13 patients with 15 CAFs detected earlier by coronary angiography. MDCT was carried out on all patients and the results were compared with coronary angiography, following which, sensitivity of MDCT was detected. Results Eleven of 15 CAFs were shown on MDCT and the overall sensitivity of MDCT was found to be 73%. Seven of 8 CAFs that coursed between two vascular structures were detected and the sensitivity of MDCT in this group was found to be 87%. However, the sensitivity of 58% of MDCT in patients with fistula coursing between coronary arteries and cardiac chambers was found. Conclusion Although coronary angiography is the gold standard diagnostic test for detection of CAF, MDCT may be an alternative test, especially, for CAF coursing between vascular structures, to detect origin, course, and the drainage site of fistula through its excellent spatial resolution and ability to show relationship of anatomic structures. Copyright © 2008 Wiley Periodicals, Inc.

Background The link between arteriosclerotic disease in the carotid or coronary artery and chronic hepatitis C virus (HCV) infection has been shown in some studies although other studies have produced contrary results. However, the effect of chronic HCV infection on the extension or severity of coronary artery disease (CAD) has not been determined so the aim of the present study was to determine the effect of HCV infection on the severity of CAD. Methods and Results The study group comprised 139 HCV seropositive and 225 HCV seronegative patients with angiographically documented CAD. A modified scoring system of Reardon et al was used. There were no significant differences between groups in terms of sex, age, hypertension, diabetes mellitus, smoking or family history. Levels of C-reactive protein and fibrinogen were significantly higher in the HCV seropositive group (p

The common coexistence with coronary artery disease has led to the suggestion that coronary artery ectasia (CAE) is a variant of coronary artery disease. The mechanisms, however, responsible for CAE formation during the atherosclerotic process and the exact clinical significance are not well known. In this study, we aimed to investigate platelet activity in patients with isolated CAE by using specific markers of platelet activation as P-selectin, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4).Thirty-two patients with isolated CAE without significant stenosis and 30 control participants with angiographically normal coronary arteries were included in this study. According to the angiographic definition used in the Coronary Artery Surgery Study, a vessel is considered to be ectasic when its diameter isor = 1.5 times that of the adjacent normal segment in segmental ectasia. Plasma P-selectin, beta-TG and PF4 levels were measured in all patients and control participants using enzyme-linked immunosorbent assay method.Patients with isolated CAE were detected to have significantly higher levels of plasma P-selectin, beta-TG and PF4 in comparison with control participants with angiographically normal coronary arteries (P-selectin: 248+/-46 vs. 154+/-32 ng/ml, respectively, P0.001; beta-TG: 51+/-19 vs. 21+/-9 ng/ml, respectively, P0.001; PF4: 58+/-23 vs. 33+/-11 ng/ml, respectively, P0.001).In conclusion, we have shown for the first time that patients with isolated CAE have raised levels of plasma P-selectin, beta-TG and PF4 compared with control participants with angiographically normal coronary arteries, suggesting increased platelet activation in patients with CAE.

Myocardial bridging is a common congenital coronary abnormality recognized primarily with systolic narrowing or 'milking effect' shown by coronary angiography. We report the case of a 58-year-old man with signs and symptoms of myocardial ischemia who underwent transthoracic echocardiography and coronary angiography. The present case suggests the clinical role of transthoracic echocardiography in demonstrating characteristic coronary flow abnormalities in patients with muscular bridge in the region of the mid LAD.

Dextrocardia is a rare cardiac anomaly in which the heart is located in the right chest along with the cardiac long axis directing to the right and inferiorly. Although, it is a rare clinical phenomenon, coronary artery disease with dextrocardia is presumed to be of similar frequency as in the general population. Percutaneous coronary intervention has some technical difficulties in these patients. We hereby report a male patient with dextrocardia who was previously treated with coronary artery bypass graft surgery.

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.

Neointimal hyperplasia is in the forefront in in-stent restenosis. Prevention of in-stent restenosis is possible by reducing and inhibiting the hyperplasia of smooth muscle cells. The authors planned this study to test the hypothesis that when administered orally, mycophenolate mofetil (MMF) could inhibit in-stent neointimal hyperplasia. The study included 14 New Zealand rabbits. The rabbits were allocated to 2 different groups: Group 1 included 7 rabbits that were given MMF, 40 mg/kg/day by oral route. Group 2 included 7 rabbits that were not given MMF after the stenting. Sampling materials were taken before and after stenting by incising the artery so as to cover a 5-mm area. The samples taken from the edge of the stent in Group 1 showed focal neointimal cell proliferation, but it was less than that from the control group. Neointimal thickness was 0.048 ±0.009 mm and neointimal area was 0.0925 ±0.019 mm2. Apparent neointimal cell proliferation and thickening of the intimal layer were observed in Group 2. Neointimal thickness at the stent edge was 0.147 ±0.051 mm and the neointimal area was 0.154 ±0.023 mm2. The differences between groups in terms of neointimal thickness and neointimal area were statistically significant (p=0.001 for thickness and p=0.001 for area). In-stent artery samples of Group 1 showed that some subjects had no neointimal cell proliferation, while others had very limited focal intimal thickening. Neointimal thickening was 0.071 ±0.003 mm and neointimal area was 0.073 ±0.003 mm2. In Group 2 apparent, and mostly focal, neointimal cell proliferation and formation of intimal layer were observed in the stent. Neointimal thickening was 0.154 ±0.069 mm and neointimal area was 0.279 ±0.059 mm2. The comparison between groups showed significant differences (p=0.011 for thickness and p=0.001 for area). It was established in the third month that endothelialization was completed in both groups. Oral MMF decreased in-stent intimal hyperplasia without edge effect. It was concluded that for the prevention of in-stent restenosis, studies should be conducted for using systemic immunosuppressive treatments in humans as well.

We evaluated the short-term results of percutaneous excimer laser angioplasty in acute myocardial infarction. Of the 18 patients studied, 2 were female and 16 male with a mean age of 56.6 ± 12.1 years. Thrombolysis in myocardial infarction grades 0, 1, and 2 flow was observed in 10, 5, and 3 cases, respectively, prior to the procedure. The degree of stenosis was 97.9% ± 5.1%. The lesion was crossed with a laser catheter in all cases, using a mean number of 808 ± 384 laser pulses. Type C dissection developed in only 1 case (6%). Except for this case, distal flow was grade 3 in all the patients. Following the procedure, ST segment resolution exceeding 70% was achieved in 14 cases (78%) within the first 90 minutes. The success rate of laser ablation was 94% (17 patients). Stent implantation was performed in all the cases. In conclusion, laser angioplasty is an effective and reliable treatment for acute myocardial infarction.

Cardiac Doppler signals recorded from mitral valve of 60 patients were transferred to a personal computer by using a 16-bit sound card. The power spectral density (PSD) was applied to the recorded signal from each patient. In order to do a good interpretation and rapid diagnosis, PSD values classified using multilayer perceptron (MLP) and neuro-fuzzy system. Our findings demonstrated that 93.33% classification success rate was obtained from MLP, 90% classification success rate was obtained from neuro-fuzzy system. The classification results show that MLP offers best results in the case of diagnosis.

OBJECTIVE The purpose of this study was to evaluate the long term effect of clopidogrel-based antiplatelet therapy on neointimal formation. METHODS This study comprised 78 patients with typical stable angina pectoris or documented myocardial ischaemia, and with only one angiographic lesion in one native coronary artery undergoing successful stent implantation without predilatation with C-reactive protein levels < or =5 mg/l at 72 h after the procedure. All patients received dual antiplatelet therapy with 75 mg/day clopidogrel and 300 mg/day aspirin for four weeks. Clopidogrel was switched to isochronous placebo in half of the patients (n=39) at the end of the fourth week. This allocation was maintained for 20 weeks, and at week 24 of the study, coronary angiography and intravascular ultrasound imaging were performed again in all cases in order to evaluate the changes that had occurred in the in-stent neointimal formation; rates of restenosis were also recorded RESULTS At the end of the follow-up period, angiographic stenosis diameter and restenosis rates were smaller in the clopidogrel group than in the placebo group (23.3% versus 35.6%, p=0.05 and 5.12% versus 10.25%; p=0.03 respectively); the intravascular ultrasonographic neointimal cross sectional area was also smaller in the clopidogrel group (3.6 +/- 2.7 mm(2) versus 5.2 +/- 2.5 mm(2), p=0.03). CONCLUSIONS Long-term clopidogrel administration significantly reduced neointimal formation at the stent site as well as reducing major clinical events in patients who did not develop high-risk systemic inflammatory response after percutaneous coronary intervention.

The aim of this study was to evaluate the effects of stenting on blood pressure and renal functions in azotemic patients with proximal/ostial atherosclerotic renal artery stenosis. Thirteen azotemic patients (5 females, 8 males, average age, 62.7 +/- 8.3 years) who had renal artery stenosis were included in the study. Their blood pressure, estimated glomerular filtration rate (EGFR), and creatinine levels were measured at baseline and during follow-up. Stents were implanted successfully in all of the cases. The average stent diameter and stent length were 7.2 +/- 0.5 mm and 17.2 +/- 3.4 mm, respectively. Antihypertensive drug was abandoned in 1 (7.6%) patient, reduced in 10 patients (76.9%), and not changed in 2 (15.3%) patients. Significant improvement was observed in the mean serum creatinine level at the 12th month when compared with baseline (2.56 +/- 0.88; 1.83 +/- 0.62, P < 0.001). EGFR was 18.38 +/- 4.64 before the procedure and 22.67 +/- 3.81 during follow-up (P < 0.0001). According to the GFR criteria, renal function was determined to be worse in 1 (7.6%) patient, stabilized in 2 (15.3%), and improved in 10 (76.9%) patients. One patient died during the follow-up period. Angiographic restenosis was observed in 2 (15.3%) patients. Follow-up major events were observed in 3 (23%) patients. Stenting azotemic patients with renal artery stenosis is a reliable and effective procedure for achieving an improvement in renal function.

Background It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients. Methods To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months’ duration). Results The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 ± 22 and 115 ± 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT. Conclusion If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.

In this paper, an intelligent system is presented for interpretation of the Doppler signals of the heart valve diseases based on the pattern recognition. This paper especially deals with combination of the feature extraction and classification from measured Doppler signal waveforms at the heart valve using the Doppler Ultrasound. Because of this, a wavelet packet neural network model developed by us is used. The model consists of two layers: wavelet and multi-layer perceptron. The wavelet layer is used for adaptive feature extraction in the time-frequency domain and is composed of wavelet packet decomposition and wavelet packet entropy. The multi-layer perceptron used for classification is a feed-forward neural network. The performance of the developed system has been evaluated in 215 samples. The test results showed that this system was effective in detecting Doppler heart sounds. The correct classification rate was about 94% for abnormal and normal subjects.

Elevated levels of C-reactive protein (CRP) are considered to be one of the indicators of poor prognosis in coronary artery disease (CAD). The aim of this study was to evaluate anti-inflammatory effects of atorvastatin in patients with CAD by measuring serum CRP levels.After measuring the baseline levels of CRP and lipid fractions, the patients were divided into two groups. In Group A (n = 46), atorvastatin (20 mg/day) was administered in addition to classic antianginal treatment (beta-blocker, nitrate and aspirin). In Group B (n = 32), the usual antianginal treatment was continued. Following 4 weeks of treatment the same measurements were repeated.In Group A, CRP decreased from 20.3 mg/dl (95% CI, 9-31.8) to 10.8 mg/dl (95% CI, 2.7-18.9) (p0.001). In Group B, CRP decreased from 17 mg/dl (95% CI, 13.1-21) to 12.8 mg/dl (95% CI, 9.7-15.9) (p0.01). The decrease in group A was more than in group B (p = 0.003).In patients with CAD, atorvastatin exerted an anti-inflammatory effect represented by decreasing CRP levels. This effect was independent of the change in low density lipoprotein cholesterol (LDL-C) or high density lipoprotein cholesterol (HDL-C) levels.