Objectives: High levels of mean platelet volume (MPV) have been shown to be a predictor of poor clinical outcome among survivors of myocardial infarction. We evaluated the association between admission MPV and infarct-related artery (IRA) patency in patients treated with thrombolytic therapy for acute myocardial infarction (AMI).
Study design: We retrospectively evaluated 133 consecutive patients with ST-elevation AMI, who received thrombolytic therapy within 12 hours of chest pain. Sixty-five patients received streptokinase and 68 patients received recombinant tissue-type plasminogen activator, based on the discretion of the physician. Blood samples were taken before thrombolytic therapy and MPV was measured. Coronary angiography was performed within a mean of two days after thrombolytic therapy and the flow in the IRA was assessed with the TIMI flow grade and corrected TIMI frame count (CTFC).
Results: After thrombolytic therapy, TIMI 3 flow was achieved in 62 patients (46.6%), whereas 71 patients (53.4%) had insufficient TIMI flow. Patients with insufficient TIMI flow had a significantly higher mean admission MPV (9.8±1.5 fl vs. 8.6±1.4 fl; p<0.001) and were more likely to have been given streptokinase (p=0.02). The two groups were similar with respect to the type of IRA and the number of diseased vessels (p>0.05). There was a weak correlation between MPV and CTFC (p=0.01). Multivariate analysis showed MPV (OR 1.871, 95% CI 1.402-2.498; p<0.001) and the type of thrombolytic agent (OR 2.915; 95% CI 1.333-6.374; p=0.007) as independent predictors of insufficient TIMI flow. The receiver operating characteristic analysis yielded a cutoff value of 8.885 fl for MPV to predict insufficient TIMI flow, with sensitivity and specificity being 70.4% and 66.1%, respectively.
Conclusion: Our findings show that a higher admission MPV is associated with an increased risk for insufficient TIMI flow in the IRA after thrombolytic therapy for AMI.

Objectives: Patients with dilated cardiomyopathy are considered a high risk group for left ventricular (LV) thrombus formation. However, the left atrial appendage (LAA) might be an additional site for thrombus formation in this patient group. We evaluated the association between LV size and left atrium/LAA size and determined the incidence of spontaneous echo contrast (SEC)/thrombus in the LV, left atrium, and LAA in patients with and without enlarged LV dimensions.
Study design: In a prospective design, we examined 45 patients with transthoracic and transesophageal echocardiography. Nineteen patients had an enlarged LV dimension (group 1: LV end-diastolic diameter ≥58 mm), and 26 patients had a normal LV size (group 2). Nonvalvular atrial fibrillation (AF) was present in 13 patients (68.4%) in group 1 and in 14 patients (53.9%) in group 2. Echocardiographic parameters included LV dimension and ejection fraction, left atrial diameter, LAA maximal area, and detection of SEC/thrombus in the LV, left atrium, and LAA.
Results: The two groups were similar with regard to demographic and clinical features. Patients in group 1 had a significantly increased LV end-diastolic diameter (63.5±3.8 mm vs. 50.9±0.9 mm; p<0.001) and decreased ejection fraction (45.3±11.7% vs. 56.0±10.2%; p=0.002). Left atrial diameter did not differ significantly, but maximal LAA area was significantly greater in group 1 (4.9±2.3 cm2 vs. 3.3±0.8 cm2; p=0.002). Among the frequencies of SEC and thrombus in the LV, left atrium, and LAA, only the frequency of thrombus in the LAA was significantly higher in group 1 (36.8% vs. 7.7%; p=0.05). Compared to patients with a normal LV size and AF, the coexistence of AF with dilated LV was significantly associated with a greater LV end-diastolic diameter (p<0.001) and LAA maximal area (p=0.02).
Conclusion: Patients with a dilated LV have a larger LAA and seem to be at a higher risk for LAA thrombus formation.

Objectives: Multislice computed tomography (MSCT) is a promising noninvasive method of detecting coronary artery disease. However, most data have been obtained in selected series of patients. The purpose of this study was to investigate the accuracy of 64-slice CT in consecutive patients with suspected or proven coronary artery disease.
Study design: Seventy-three consecutive patients (57 males, 16 females; mean age 59±9 years; range 33 to 83 years) were examined by 64-slice CT before coronary angiography (CA). Eight patients had a history of percutaneous coronary intervention and stenting and five patients had a history of coronary artery bypass grafting. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of MSCT for the detection of significant stenosis were calculated on a segmental, vessel, and patient basis.
Results: Sixty-one patients were diagnosed as having at least one significant stenosis with CA. Of these, MSCT identified 58 patients correctly. Two patients were incorrectly diagnosed as having one-vessel disease by MSCT. Patient-based sensitivity, specificity, NPV, and PPV of MSCT were 95.1%, 83.3%, 76.9%, and 96.7%, respectively. Of 1065 segments evaluated, CA detected 141 significant stenoses. On MSCT, significant stenoses were correctly diagnosed in 116 segments. Twenty-four nonsignificant lesions were overestimated by MSCT. In segment-based analysis, the overall sensitivity was 82.3%, specificity was 97.4%, NPV was 97.3%, and PPV was 82.9%. The accuracy of MSCT was in full agreement with CA in the evaluation of stent and graft patency.
Conclusion: Our findings show that 64-slice CT is highly accurate for the detection of significant coronary artery disease in an unselected patient population and can be used as a noninvasive technique.

Objectives: We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
Study design: We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5±11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion.
Results: Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9±13.5 years vs. 56.4±11.8 years; p<0.001), exhibited higher frequencies of female gender (p=0.016), renal failure (p<0.001), and admission anemia (p<0.001), and had a lower procedural success rate (77.9% vs. 91.5%; p=0.02). The development of GIB was associated with significantly higher in-hospital mortality (18.5% vs. 2.9%; p<0.001), longer hospital stay (13.1±6.8 days vs. 7.0±3.7 days, p=0.02), and increased inotropic requirement (37% vs. 6.7%; p<0.001). In multivariate analysis, inotropic requirement (OR 4.17, 95% CI 1.7-10.4; p=0.002), age above 70 years (OR 3.33, 95% CI 1.4-8.0; p=0.007), and glomerular filtration rate lower than 60 ml/min/1.73 m2 (OR 2.96, 95% CI 1.2-7.4; p=0.02) were independent predictors of in-hospital GIB.
Conclusion: The development of GIB is not an uncommon complication after primary PCI for STEMI. These patients have a prolonged hospital stay and increased in-hospital mortality. Increased inotropic requirement, age above 70 years, and impaired renal function are independent predictors of this complication.

Objectives: We aimed to evaluate epidemiological, clinical, and microbiological features of infective endocarditis (IE) in a tertiary university hospital.
Study design: The study included 72 patients (31 women, 41 men; mean age 45±16 years; range 18 to 80 years) who were diagnosed as having definite IE, according to the modified Duke criteria, between 2004 and 2007. Data were reviewed on age, sex, underlying heart disease, predisposing conditions for bacteremia, echocardiographic and microbiological findings, treatment, complications, and mortality.
Results: Infective endocarditis developed on a native valve in 47 (65.3%), a mechanical prosthetic valve in 21 (29.2%), and a pacemaker in two cases. The location of IE could not be determined in two cases (2.8%). Rheumatic heart disease (36.1%) was the most common preexisting valvular abnormality. The mitral valve was the most commonly affected valve in both native valves (43.1%) and prosthetic valves (13.9%). The most frequent symptom was fever (n=60, 83.3%). Electrocardiography showed abnormal findings in 24 cases (33.3%). Transthoracic and/or transesophageal echocardiography showed a vegetation in 63 cases (87.5%), moderate or severe mitral regurgitation in 41 cases (56.9%), aortic regurgitation in 21 cases (29.2%), and tricuspid regurgitation in 29 cases (40.3%). Staphylococci (26.4%) and streptococci (22.2%) were the most common causative agents. Cultures were negative in 26 cases (36.1%). Twenty patients (27.8%) underwent surgical treatment. Congestive heart failure (n=23, 31.9%) and cerebrovascular accidents (n=10, 13.9%) were the major complications. In-hospital mortality occurred in 11 cases (15.3%).
Conclusion: Our data reflect epidemiological, clinical, and microbiological profile of IE in a tertiary hospital located in the Southeastern Anatolia.

Sinus node artery originates from the proximal segment of the right coronary artery, left circumflex artery, or from both. We present a 55-year-old man who underwent coronary angiography for exercise-induced chest pain localized in the epigastric region that resolved within several minutes of resting. He had an anomalous sinus node artery originating from the left anterior descending artery and right coronary artery agenesis. To our knowledge, this is the first reported case of coexistence of these two rare coronary anomalies.

Central venous catheterization which is frequently used for hemodynamic monitoring represents a high risk for catheter-related complications. Tricuspid valve dysfunction associated with central venous catheterization is very rare. A 22-year-old woman with acute renal failure was scheduled for hemodialysis. After completion of catheter placement, attempts to remove the guide wire failed. Radiographic examination was not helpful in showing the extension of the wire. Transthoracic echocardiography showed tricuspid valve motion upon the movement of the guide wire. Color Doppler imaging revealed mild to moderate tricuspid regurgitation. A right atriotomy was performed through a right anterolateral thoracotomy to remove the guide wire entrapped in the tricuspid chordae. Postoperative transthoracic echocardiography showed complete disappearance of tricuspid dysfunction.

A 45-year-old man presented to the emergency department with acute oppressive chest pain. On physical examination, a loud decrescendo diastolic murmur of grade 2-3/6 was audible on the left sternal edge. The electrocardiogram was within normal limits and there were no signs of myocardial ischemia. Transthoracic echocardiography revealed an acute type A aortic dissection with an intimal flap prolapsing into the left ventricular outflow tract through the aortic valve during diastole. Color Doppler examination showed severe aortic regurgitation of grade 3. The aortic valve had three leaflets with normal thickness. Aortic diameter was 50 mm at the sinus of Valsalva and 66 mm after the sinotubular junction. The left and right ventricles were normal in size and function. Dynamic thorax and abdominal computed tomography demonstrated that the dissection flap extended from the ascending aorta to the proximal segments of the common iliac arteries. The patient underwent successful ascending aorta replacement with preservation of the aortic valve.

Single coronary artery is described as an isolated coronary artery originating from the aortic root through a single ostium in the absence of another ostium, where isolated coronary artery is the only source for blood supply to the whole heart. We present a 53-year-old woman whose coronary angiography for typical chest pain revealed an isolated single coronary artery. On coronary angiography, the whole coronary system originated by a single trunk from the right sinus of Valsalva. Multislice computed tomography showed that the left anterior descending, circumflex, and right coronary arteries arose from a single ostium in the right sinus of Valsalva without a left main trunk. Despite maximal medical therapy, her chest pain persisted. The patient did not accept surgical treatment proposed for correction of the anomaly.

Ebstein’s anomaly (EA) is a malformation of the tricuspid valve characterized by a downward displacement of the septal and often the posterior tricuspid valve leaflets to the atrialized right ventricle. Among all congenital anomalies, EA is the most related malformation with accessory pathways. In 5%-25% of patients with EA, accessory atrioventricular pathways may present on the surface electrocardiogram. Radiofrequency catheter ablation is the first-line treatment of EA patients having supraventricular tachyarrhythmias. The presence of a dysplastic tricuspid annulus and electrically distinguishable atrioventricular activity may complicate radiofrequency catheter ablation of accessory pathway tachycardia in these patients. We present three cases of EA in which accessory pathway tachycardias were successfully ablated, with emphasis on technical difficulties in electrophysiological diagnosis and during radiofrequency ablation.

Several studies have compared the efficacy of elective coronary artery stenting and coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery (ULMCA) disease. However, a definite reperfusion modality has yet to be established in ST-elevation myocardial infarction (STEMI) due to acute total occlusion of ULMCA, which has catastrophic clinical results. We presented five patients (3 males, 2 females; mean age 59 years; range 53 to 67 years) with acute anterior STEMI and angiographically documented acute total occlusion of ULMCA. On presentation, all the patients had chest pain and four patients were in cardiogenic shock. All the patients were taken to the catheterization room with minimum delay. Intra-aortic balloon counterpulsation was used during coronary angiography in all the patients. Three patients underwent PCI and, after balloon predilatation, bare-metal stents were implanted and TIMI III flow was achieved. One patient who had atrial fibrillation on admission died on the 14th day of hospitalization after PCI due to pump failure. After diagnostic coronary angiography, two patients were submitted to surgery for emergency CABG. They both died, one within two hours of admission during preparation of the surgical team, and the other on the third postoperative day. Both were in cardiogenic shock on admission.

Sleep-disordered breathing is one of the important factors contributing to the development and/or progression of heart failure (HF). This condition is related to recurring attacks of apnea, hypopnea, and hyperpnea, sleep disruptions, arousals, intermittent hypoxemia, hypocapnia, and hypercapnia, and intrathoracic pressure changes. Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction (apnea and hypopnea), increased breathing effort against totally or partially occluded upper airway, and sleep disruptions. Cardiovascular consequences are the most serious complications of OSA and include acute myocardial infarction, heart failure, left/right ventricular dysfunction, arrhythmias, stroke, and systemic and pulmonary hypertension. Cheyne-Stokes respiration and central apneas may also occur in patients with HF. This article reviews the most recent information on the physiopathology, diagnosis, and treatment modalities of obstructive and central apneas in patients with HF.