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AngIopoIetIn-1, angIopoIetIn-2 and
VEGF levels In stable angIna pectorIs patIents and theIr
relatIonshIp wIth angIographIcally severIty of coronary artery
dIsease
Tavakkoli S.A, Atalar E, Özer N, Övünç
K, Aksöyek S, Özmen F.
Growth factors have
important role in development of coronary atherosclerosis and have
regulatory effects in coronary collateral formation. Diabetes mellitus to be
a prototype, many other factors affect collateral formation. In this study,
our aim was to measure growth factor levels in stable coronary artery
disease and to ellucidate their possible relationship with coronary artery
disease severity and degree of collateral formation. Patients with stable
angina pectoris who had an indication for coronary angiography were included
in this study. Femoral arterial blood samples were drown just before the
coronary angiography. Patietns with less than %50 stenosis in their coronary
arteries were considered as control (n=20, mean age 55 10 years) and those
with %50 or more considered as coronary artery disease (CAD) group (n=40,
mean age 59 11 years). Coronary disease severity was classified as 1, 2, or
3 vessel disease. Coronary collateral presence was assessed by
angiographically visible or invisible collateral vessels. Plasma
Angiopoietin-1 levels were similar in patient and control groups (194±84 pg/ml
vs. 173±73 pg/ml respectively, p=0.3). Plasma Ang-2 levels were higher in
patient group with respect to control group (425±156 pg/ml vs. 251,0±81 pg/ml
respectively, p=<0.0001). Vascular endothelial growth factor (VEGF) levels
were also higher in patient group (17±8 pg/ml vs. 9.8±6.6 pg/ml respectively,
p=0.003). In patents with CAD, plasma Ang-1 (p=0.6), Ang-2 (p=0.2) and VEGF
(p=0.4) levels were similar in those with and without diabetes . In patients
with coronary total occlusion VEGF levels (p=0.001), in patients with
coronary collaterals VEGF levels (p=0.005) and Ang-2 levels (p=0.003) were
also higher. In conclusion, Plasma VEGF and Ang-2 levels were increased and
similar in CAD patients with and without diabetes. Plasma VEGF and Ang-2
levels were also increased in patients with coronary collaterals.
The effect of clInIcal characterIstIcs,
treatment approaches, clInIcal outcomes In rescue percutaneous coronary
InterventIon after faIled thrombolysIs
Taçoy G, Yazıcı E.G,
Kocaman A.S, Timurkaynak T.
Rescue percutaneous
coronary intervention (PCI) is known as mechanical
revascularisation treatment after failed thrombolytic
therapy in patients with acute myocardial infarction (MI).
Despite rescue PCI has advantages in restoring blood flow in
infarct related coronary artery promptly, there are
conflicting results on mortality and morbidity in recent
studies. Therefore we aimed to describe the clinical
characteristics, treatment approaches, clinical outcomes of
patients in whom rescue PCI after failed thrombolytic
therapy was applied.
Thirty seven patients who were hospitalized with ST segment
elevation MI in Cardiology Department of Gazi University and
in whom thrombolytic therapy failed and therefore rescue PCI
was applied were enrolled into this descriptive study. The
clinical characteristics, treatment approaches, short-term
clinical outcomes were recorded. Coronary angiograms before
and after the revascularization procedure were evaluated
with quantitative coronary angiogram (QCA) technique.
The study population was consisted of 34 (90%) male patients
and the mean age was 56.6±10.7. HT in 16 (43%), diabetes
mellitus (DM) in 5 (13.5%), smoking in 23 subjects were seen.
Mean time from symptom onset to rescue PCI was 7.5±5.2 hr.
During rescue PCI 4 patients (10%) experienced cardiac
arrest, 2 patients (5%) required emergency coronary artery
bypass graft (CABG) operation. The left anterior descending
artery was the infarct related artery (IRA) in 49% ,
circumflex artery in 19%, right coronary artery in 32% of
the study population. Thrombus was present before PCI in all
of the patients. Coronary stents were implanted in 89%.
Intraaortic balon pump and glycoprotein IIb/IIIa inhibitors
were used in 7 patients (19%). Two patients (5%) died during
their hospital course. Bleeding complications occured in 5
(11%) patients and were in vascular access sites. Infarct
related artery (IRA) was totally occluded in 26 patients
(70%) before rescue PCI. There were no significant
differences between the patients in whom IRA was totally
occluded and the rest of them. Patients in whom rescue PCI
was performed in 5 hours from the onset of chest pain, had
better quantative angiographic values before the procedure
compared to patients whom rescue PCI was performed >5 hours
(p<0.05), but the postprocedure values were similar between
two groups. After rescue PCI, TIMI III blood flow was found
in 23 patients (62%).
Patients characteristics, treatment approaches and mortality
rate of our study population is well-matched with current
data except glycoprotein IIb/IIIa inhibitor use. The low
ratio of TIMI III blood flow after rescue PCI may be
explained by lower use rate of glycoprotein IIb/IIIa
inhibitors in this population.
The relatIonshIp between the level of plasma
osteopontIn and coronary artery calcIfIcatIon and coronary artery dIsease
Aryan M, Özmen F, Atalar
E, Özer N, Aksöyek S, Övünç K.
One third of sudden death and acute
myocardial infarction (AMI) occur in asemptomatic patients who didnot have
semptom before the event they just have already experienced. Therefore,
early diagnosis of asemptomatic coronary artery disease (CAD) is fairly
important. Coronary calcium scoring by tomographic method is often used for
this target. However, there are some attractive ongoing investigations
regarding plasma osteopontin, whether it has relation with coronary
calcification and CAD. In this regard, the aim of this prespective study was
to investigate whether there is positive correlation between the coronary
artery calcium score and CAD and plasma osteopontin levels.
Is hypoadIponectInemIa the rIsk factor
for coronary artery dIseAse?
Öztürk Ü, Karaca I, Yavuzkır M, Dağlı
N, Polat V, Balin M.
There has
been a failure in showing classical risk factors in a vast
majority of coronary artery disease (CAD) patients. This
suggests that the classification based on currently used
risk factors is not adequate and that some risk factors
other than conventional ones play a part in the
atherosclerotic process. With its anti-inflammatory and
antiatherogenic activity, adiponectin is known to have
preventive effects in the onset and progression of
atherosclerosis. Our objective in this study is to examine
whether hypoadiponectinemia is a risk factor for coronary
artery disease.
The study included a total of 50 cases, of whom 25 were CAD
patient group (mean age: 56.3±10.7years, 20 male, 5 female)
and 25 control group cases (mean age 55.0±9.2 years, 17 male,
8 female). Individuals whose coronary angiography showed a
normal coronary anatomy were accepted as the control group.
Cases who had greater than 50% luminal stenosis in at least
one coronary artery were regarded CAD. Adiponectin levels
were studied in 2002 model "Triturus" make (Grifols,
Barcelona, Spain) ELISA reader with a "Human Adiponectin
Sandwich ELISA kit (Chemicon, USA) and recorded as µg/dL.
Serum adiponectin levels were measured 3.30±1.96 µg/dL in
the CAD group and 6.73±4.0 µg/dL in the control group. The
difference was statistically significant (p<0.001). Backward
regression was formed to establish the predictive value of
adiponectin in predicting the presence of CAD. This analysis
significantly predicted the presence of CAD (x2=15.329, df=1,
p=0.001, R2=0.229). The analysis showed that adiponectin was
an effective factor in predic-ting the presence of CAD
[ß=0.725, p=0.001, 95% CI (0.604-0.870)]. In the last step,
the accurate classification performance of this logistic
regression model was 77.3%.
We found low plasma adiponectin levels in coronary artery
disease patients. We think that plasma adiponectin level can
be a valuable cytokine in predicting CAD. Thus,
hypoadiponectinemia can be a risk factor for CAD.
The fIrst percutaneous translumInal coronary
angIoplasty In the world and Turkey
Özmen F.
The first coronary
angiography has applied in 1959 by M. Sones. This has been
milestone of the modern cardiology and interventional
cardiology. The first percutaneous transluminal coronary
angioplasty (PTCA) has applied by Andreas Gruentzig at 1977.
Coronary angioplasty has shown distinctive developments in
every level of coronary angioplasty process to reach the
present state.
Between 1950-1970 the rapid improvements image intensifier,
the important improvements in the quality of flouroscopic
image, has played powerful role in the development of
coronary angioplasty. The improvements in balloon and guide
wire technology has played very important role in the
coronary angioplasty of complex lesions and multivessel
disease.
In balloon angioplasty, the rate of restenosis has found
high and at the and of the studies for the solution of the
problem, new techniques have improved. But the new tecniques
(directional atherectomy, rotational atherectomy, laser
ablation and others) did not give the demanded results for
the restenosis. Between the new tecniques only the stent
implantations promised hope for the future and decreased the
need of coronary artery bypass surgery of coronary artery
patients. Its frequency of restenosis is lower comparing to
balloon angioplasty and other new techniques. After the
stent implantation because of not bringing the restenosis
rate to the demanded level, drug-eluted stents are tested
and relatively positive results abtained. Sirolimus is the
first studied drug between drung-eluted stents.
Key Words: Coronary angiography, Coronary angioplasty,
New techniques, Stent, Re-stenosis
Could EustachIan valve be rIsk factor for
pulmonary embolI?
Kurt İ.H.
While pulmonary embolism is
common, it is not always possible to determine its risk
factors. Recently, it has been noted that a portion of
thrombi localized in the right atrium could accompany
congenital structures such as eustachian valve. Eustachian
valve and thrombus have been identified in the right atria
of two cases diagnosed with pulmonary embolism, one
occurring after the childbirth and the other one with
chronic pulmonary disease. Eustachian valve and associated
thrombus development in the right atrium may predispose to
pulmonary embolism by forming a mechanic barrier in the
presence of recurring pulmonary embolism.
Key Words: Eustachian valve, Right atrial thrombus,
Pulmonary embolism
Biçer A, Akdemir R, Kılıç
H, Balcı M, Eryaşar N.E.
Central
venous catheters are used routinely for parenteral nutrition,
chemotherapy, invasive measurement of hemodynamic variables
at intensive care units, infusion of large amount of fluids
or blood products, chronic access for hemodialysis.
Infection is the most important clinical complication
associated with the use of central venous catheters, both in
terms of incidence and of gravity.
In this report we describe the case of a 38-year-old woman
with central venous catheter which suspected right-sided
infective endocarditis or catheter infection because of
clinic and laboratory findings.
Emergency
coronary bypass operatIon on the angIography. A case report
Erdoğan M.B, Yardımcı M,
Batyraliev T, Kısacıkoğlu B.
Interventional
cardiologic procedures may lead to lethal complications such
as coronary artery dissection, coronary artery occlusion,
and coronary artery perforation. Coronary bypass surgery on
the angiography table might be inevitable. A case who was
suffering ventricular fibrillation resistant to the
defibrillation occurred after coronay artery perforation was
operated on angiography table. Cardiac tamponade had
resolved when pericardium was opened, but aortocoronary
bypass was performed with a saphenous vein to right coronary
artery under cardiopulmonary bypass (CPB) due to ongoing
venticular fibrillation. Patient was weaned from CPB
succesfuly and discharged from hospital on 6th day.
